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Symptoms and Signs of Attention Deficit Hyperactivity Disorder in Children (ADHD in Children)

Doctor's Notes on Attention Deficit Hyperactivity Disorder in Children (ADHD in Children)

Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral disorder characterized by hyperactivity, impulsivity, and/or inattention and may result in difficulty in academic, emotional, and social functioning. There are 3 types of ADHD: primarily inattentive, characterized by recurrent inattentiveness and inability to maintain focus on tasks or activities; primarily hyperactive-impulsive, characterized by impulsive behaviors and inappropriate movement or restlessness; and combined, the most common type of ADHD, which is a combination of inattentive and hyperactive-impulsive forms.

Symptoms of inattention present in attention deficit hyperactivity disorder in children may include failure to pay attention to details, making careless, difficulty sustaining attention in tasks or play activities, does not seem to listen when spoken to directly, does not follow through on instructions and fails to finish tasks, difficulty organizing tasks and activities, reluctant to engage in tasks that require sustained mental effort, loses things necessary for tasks or activities, is easily distracted, and often forgetful. Symptoms of hyperactivity in ADHD in children may include fidgeting, leaving seat in classroom or in other situations in which remaining seated is expected, runs about or climbs excessively in situations in which it is inappropriate, has difficulty playing or engaging in leisure activities quietly, and talks excessively. Symptoms of impulsivity in ADHD in children may include blurting out answers before questions have been completed, difficulty awaiting turn, and interrupting or intruding on others.

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 3/11/2019

Attention Deficit Hyperactivity Disorder in Children (ADHD in Children) Symptoms

The symptoms of attention deficit hyperactivity disorder (ADHD) are not physical symptoms such as ear pain or vomiting but rather exaggerated or unusual behaviors. The type and severity of symptoms vary greatly among people with ADHD. The severity of symptoms depends on the degree of abnormality in the brain, the presence of related conditions, and the individual's environment and response to that environment.

The diagnostic criteria for ADHD are outlined in the Diagnostic and Statistical Manual of Mental Health, 5th ed. (DSM-V 2013) by the American Psychiatric Association. All of the symptoms of inattention, hyperactivity, and impulsivity must have persisted for at least six months to a degree that is maladaptive and inconsistent with the developmental level of the child.

Inattention

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
  • Often has difficulty sustaining attention in tasks or play activities
  • Often does not seem to listen when spoken to directly
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
  • Often has difficulty organizing tasks and activities
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  • Often loses things necessary for tasks or activities (for example, toys, school assignments, pencils, books, or tools)
  • Is often easily distracted by extraneous stimuli
  • Is often forgetful in daily activities

Hyperactivity

  • Often fidgets with hands or feet or squirms in seat
  • Often leaves seat in classroom or in other situations in which remaining seated is expected
  • Often runs about or climbs excessively in situations in which it is inappropriate
  • Often has difficulty playing or engaging in leisure activities quietly
  • Often talks excessively

Impulsivity

  • Often blurts out answers before questions have been completed
  • Often has difficulty awaiting turn
  • Often interrupts or intrudes on others (for example, butts into conversations or games)

In addition, some hyperactive, impulsive, or inattention symptoms that cause present difficulties were present before 7 years of age and are present in two or more settings (at school [or work] or at home). There must be clear evidence of significant impairment in social, academic, or occupational functioning, and the symptoms are not entirely caused by another severe physical disorder (for example, severe illness associated with chronic pain) or mental disorder (for example, schizophrenia, other psychotic disorders, severe disabling mood disorders, etc.).

Inattention symptoms are most likely to manifest at about 8 to 9 years of age and commonly are lifelong in duration. The delay in onset of inattentive symptoms may reflect its more subtle nature (versus hyperactivity) and/or variability in the maturation of cognitive development. Hyperactivity symptoms are usually obvious by 5 years of age and peak in severity between 7-8 years of age. With maturation, these behaviors progressively decline and generally have been "outgrown" by adolescence. Impulsive behaviors are commonly linked to hyperactivity and also peak at about 7-8 years of age; however, unlike their hyperactive counterpart, impulsivity issues remain well into adulthood. Impulsive adolescents are more likely to experiment with high-risk behaviors (drugs, sexual behavior, driving, etc.). Impulsive adults have a higher rate of financial mismanagement (impulse buying, gambling, etc.).

Many children without ADHD may also demonstrate one or more of these behaviors. However, the difference between these children and the child with ADHD is that the behaviors are disruptive, are considered inappropriate for the child's developmental stage, persist for months or years, and occur both at home and at school. A child with ADHD almost never exhibits all of the symptoms, but the symptoms that are present appreciably hinder the child's social, psychological, and/or educational development.

The behaviors of ADHD can mimic mood disorders (for example, bipolar disorder or depression), anxiety, or personality disorder. Those conditions must be ruled out or adequately treated before a definitive diagnosis of ADHD can be made.

Attention Deficit Hyperactivity Disorder in Children (ADHD in Children) Causes

The pathogenesis (cause) of ADHD has not been totally defined. One theory springs from observations regarding variations in functional brain-imaging studies between those with and without symptoms. Similar variations have been shown in studies of the structure of the brain of affected and unaffected individuals. Animal studies have demonstrated differences in the chemistry of brain transmitters involved with judgment, impulse control, alertness, planning, and mental flexibility. A genetic predisposition has been demonstrated in (identical) twin and sibling studies. If one identical twin is diagnosed with ADHD, there is a 92% probability of the same diagnosis in the twin sibling. When comparing nonidentical twin sibling subjects, the probability falls to 33%. Overall population incidence is felt to be 8%-10%.

Genes that control the relative levels of chemicals in the brain called neurotransmitters seem to be different in ADHD, and levels of these neurotransmitters are out of normal balance.

  • MRI and other imaging studies suggest that these imbalances occur in parts of the brain that control certain types of movement and executive functions.
  • These areas of the brain may be smaller and/or less active in people with ADHD.

The six major tasks of executive function that are most commonly distorted with ADHD are the following:

  • Shifting from one mind-set or strategy to another (that is, flexibility)
  • Organization (for example, anticipating both needs and problems)
  • Planning (for example, goal setting)
  • Working memory (that is, receiving, storing, then retrieving information within short-term memory)
  • Separating emotions from reason
  • Regulating speech and movements appropriately

ADHD Symptoms in Children Slideshow

ADHD Symptoms in Children Slideshow

Attention deficit hyperactivity disorder (ADHD) is a disorder that affects behavior. A recent national study reported by the CDC noted that 11% of school aged children are being diagnosed with ADHD. Three main symptoms define ADHD including inattention, hyperactivity, and impulsivity. The symptoms are severe enough to affect the child's behavior in social situations and at school. The criteria for ADHD diagnosis were established in the Diagnostic and Statistical Manual of Mental Health (DSM-IV; American Psychiatric Association) in 1994. To be diagnosed with ADHD, a child must exhibit the symptoms outlined in this slideshow for at least six months.

REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.

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