Attention Deficit Hyperactivity Disorder (ADHD)

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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• ADHD Overview
• ADHD Causes
• ADHD Symptoms
• When to Seek Medical Care
• Exams and Tests
• Is ADHD on the Increase? If So, Why?
• Can a Preschool-Aged Child Be Diagnosed With ADHD?
• ADHD Treatment
• Medical Treatment
• Medications
• What Are the Risks of the Use of Stimulant Medication and Other Treatments?
• Other Therapy
• Follow-up
• Prevention
• Prognosis
• Support Groups and Counseling
• For More Information
• Synonyms and Keywords
• Authors and Editors
• Read more on Attention Deficit Hyperactivity Disorder from Healthwise
• Viewer Comments: Attention Deficit Hyperactivity Disorder - Treatment

ADHD Overview

Attention deficit hyperactivity disorder (ADHD) refers to a chronic condition that initially manifests in childhood and is characterized by problems of hyperactivity, impulsivity, and/or inattention. Not all affected individuals manifest all three behavioral categories. These symptoms have been associated with difficulty in academic, emotional, and social functioning. The diagnosis is established by satisfying specific criteria, and the condition may be associated with other neurological, significant behavioral, and/or developmental/learning disabilities. Therapy may consider the use of medication, behavioral therapy, and adjustments in day-to-day lifestyle activities.

ADHD is one of the most common disorders of childhood. ADHD occurs two to four times more commonly in boys than girls (male to female ratio 4:1 for the predominantly hyperactive type versus 2:1 for the predominantly inattentive type). While previously believed to be "outgrown" by adulthood, current opinion indicates that many children will continue throughout life with symptoms that may affect both occupational and social functioning.

The medical community recognizes three basic forms of the disorder:

• Primarily inattentive: recurrent inattentiveness and inability to maintain focus on tasks or activities. In the classroom, this may be the child who is "spacing out" and "can't stay on track."



• Primarily hyperactive-impulsive: Impulsive behaviors and inappropriate movement (fidgeting, inability to keep still) or restlessness are the primary problems. Unlike the inattentive ADHD-type child, this individual is more often the "class clown" or "class devil" -- either manifestation leads to recurrent disruptive problems.



• Combined: This is a combination of the inattentive and hyperactive-impulsive forms.

The combined type of ADHD is the most common. The predominantly inattentive type is being recognized more and more, especially in girls and in adults. The predominantly hyperactive-impulsive type, without significant attention problems, is rare.

We are still learning about ADHD, and experts' ideas of the disorder are still being shaped. Some believe, for example, that the term "attention deficit" is misleading.

• They maintain that people with ADHD are actually able to pay attention too well, rather than too little, but have difficulty regulating their attention, leaving them unable to properly focus.



• Others have trouble ignoring irrelevant details and/or focus so intensely on specific details that they miss the bigger, more important, picture.



• Many ADHD sufferers cannot shift gears from one thing to another when they need to, leaving them unable to focus on what needs to be done. Extreme difficulty getting a child to stop playing a video game to come to dinner is a common example.

Contrary to some media accounts, attention disorders are not new. Childhood hyperactivity was a focus of interest in the early 1900s. Today, hyperactivity, impulsivity, and inattention are the focus, but disability related to hyperactivity and distractibility has been alluded to throughout medical history. Historical figures of diverse backgrounds and accomplishment have demonstrated behavior compatible with ADHD. Mozart composed and remembered entire musical compositions but disliked the tedious task and attention to detail necessary when transcribing to paper. Einstein would spend hours and even days sitting quietly in a chair doing "thought experiments," including complex series of mathematical calculations and revisions. Ben Franklin failed in school due to his perfectionist and impulsive behaviors. He later mastered five languages (self-taught) and was highly respected as an author, scientist, inventor, and businessman (publisher). What is new is the greater awareness of ADHD thanks to rapidly mounting research findings.

In the United States, ADHD affects about 3%-10% of children. Similar rates are reported in other developed countries such as Germany, New Zealand, and Canada.

• In most cases, the unusual behaviors are noticed by the time the child is about 7 years old, although ADHD is occasionally diagnosed in teenagers or young adults. Children with ADHD are often noted to be emotionally delayed, with some individuals having a delay in maturity of up to 30% when compared with their peers. Thus a 10-year-old student may behave like a 7-year-old; a 20-year-old young adult may respond more like a 14-year-old teenager.



• Boys are more likely than girls to be diagnosed with ADHD. At one time, the ratio of boys to girls with ADHD was thought to be as high as 4:1 or 3:1. This ratio has been decreasing, however, as more is known about ADHD. For instance, greater recognition of the inattentive form of ADHD has increased the number of girls diagnosed with the disorder.



• People identified with ADHD in adulthood are almost as likely to be women as men, suggesting that we may have been missing the diagnosis in many young girls. Approximately one-quarter of those with ADHD have significant learning disabilities, including problems with oral expression, listening skills, reading comprehension, and mathematics.

There is disagreement over whether ADHD persists as children grow into adults.

• Some believe that most children simply grow out of ADHD. Others believe that ADHD persists into adulthood. Estimates of the number of children with ADHD who continue to have the disorder in adulthood range from 30%-80%.



• Hyperactive symptoms may decrease with age, usually diminishing at puberty, perhaps because people tend to learn how to gain greater self-control as they mature.



• Inattention symptoms are less likely to fade with maturity and tend to remain constant into adulthood.



• As we learn more about ADHD, certain subtypes will likely be found to cause more adult dysfunction than others.

People with ADHD are much more likely than the general population to have other related conditions such as learning disorders, restless legs syndrome, ophthalmic convergence insufficiency, depression, anxiety disorder, antisocial personality disorder, substance abuse disorder, conduct disorder, and obsessive-compulsive behavior. People with ADHD are also more likely than the general population to have a family member with ADHD or one of the related conditions.