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Attention Deficit/Hyperactivity Disorder in Children and Adolescents

Attention deficit/hyperactivity disorder (ADHD) in children and adolescents is a condition where children show signs of inattention, hyperactivity and/or impulsivity.  Children and adolescents with ADHD are in constant motion; they are easily distracted, have a difficult time listening, will squirm and fidget, will often talk excessively, interrupt others, have difficulty finishing assignments or other tasks and will have difficulty playing quietly and calmly.

How common is ADHD in children and adolescents?
ADHD is the most common behavior disorder in childhood. It affects between 8% and 10% of school age children and adolescents. Typically diagnosed in childhood, ADHD continues into the teenage years in the majority of these children. The symptoms -- inattention, impulsivity, and hyperactivity - are intrusive, which means they interrupt and seriously interfere with the child’s life.

What causes ADHD?
There is no definitive cause for ADHD but it is believed that it is related to structural and functional imbalances in the brain.

Although scientists have examined the relationship between food coloring and hyperactive behavior in children for many years, nothing definitive has been determined. To date, no conclusive evidence has been found to show that food coloring causes ADHD, though some studies suggest some association between ADHD and food coloring. Most likely, ADHD is caused by the combination of changes in brain structure, environmental factors, and heredity.

How is ADHD diagnosed in children and adolescents?
In order to be diagnosed with ADHD, the child must show six or more specific symptoms of inattention or hyperactivity on a regular basis for more than six months in more than two settings. There is no single test for ADHD. 

A psychiatrist or psychologist can diagnose ADHD by gathering information from several sources, including school, caregivers, and parents. The doctor will consider how a child's behavior compares with that of other children the same age. The doctor will often follow the guidelines established by the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association

Sometimes children will display some behaviors that may appear ADHD related, but are not.  These behaviors may be caused by a variety of other factors, including anxiety and depression; medical disorders affecting the brain, such as seizures, or sudden changes in the family environment such as divorce, a death in the family, moving to a new neighborhood/school etc. At times ADHD may coexist with other conditions including learning disabilities, anxiety disorders, and mood disorders. In addition, teens with ADHD may also have oppositional defiant disorder or conduct disorder. Thus, it is extremely important for the doctor to obtain an accurate differential diagnosis, with a full understanding of what diagnosis may be ruled out or what other diagnosis coexists.  

ADHD in children and adolescents is usually diagnosed in children between the ages of 4-18 years.  However, it is often difficult to diagnose ADHD in children younger than 5 years, since many of the classic ADHD symptoms are typical of pre-school children and because children develop very rapidly during these pre-school years. 

There are several categories of ADHD in children and adolescents.  These include:

- Combined Type (Inattentive/Hyperactive/Impulsive). Children with this type of ADHD show all three symptoms. This is the most common form of ADHD.
- Hyperactive/Impulsive Type. Children show both hyperactive and impulsive behavior, but for the most part, they are able to pay attention. 
- Inattentive Type. Formerly known as attention deficit disorder (ADD), these children are not overly active. They do not disrupt the classroom or other activities, so their symptoms might not be noticed.

What are the signs and symptoms of ADHD in children and adolescents?
Children and teens display similar symptoms of ADHD, including distractibility, irritability, poor concentration, hyperactivity and impulsivity. They may be constantly in motion, or they may be able to sit quietly, depending on the type of ADHD they present with.  In teens, ADHD may be intensified due to hormonal changes. 

Children and teens with ADHD will have difficulty in school. They may often forget assignments, misplace textbooks, and become easily bored with their daily class work. They may become inattentive, or excessively attentive -- not waiting for their turn before blurting out answers. They may interrupt the teacher and classmates, and rush through assignments. Children and teens with ADHD may also be fidgety and have a difficult time sitting still in class. Children and teens with ADHD may perform poorly in school which can also lead to a secondary problem of rejection by peers or rejection from other school activities. 

In adolescence, specific problems arise in relation to ADHD.   Teens with ADHD are two to four times more likely to have a car accident than teens without ADHD. Teens with ADHD may be impulsive, risk-taking, immature in judgment, and thrill seeking.  Still, studies show that teen drivers with ADHD who take the prescribed medication have a significantly reduced chance of accidents.   Another specific problem is with drugs and alcohol; studies indicate that teens with ADHD are also more likely to have significant problems with drugs or alcohol.

What is the best treatment for ADHD in children and teens?
A combination of medication and behavior management therapy has been shown to be the most effective treatment for ADHD in children and adolescents. There are several commonly prescribed medications including stimulants, such as Ritalin, Concerta, Metedate, Dexedrine or Adderall, to name a few, and Strattera, which is not a stimulant.  Side effects may include reduced appetite, sleep problems, feeling jittery, stomach upset, and acne. These side effects may start at the beginning of treatment and often get better after a short period of time.

Behavioral management therapy in the treatment of ADHD involves a team approach.  Parents, teachers, doctors and therapists all work together to set clear goals and establish rewards and consequences for the child’s behavior. Good behavior should be reinforced immediately in a verbally positive way and perhaps with a special privilege, while negative behaviors might require time out or losing a privilege.  Psycho-education about ADHD is essential for both the child and the family.

Other forms of ADHD treatment that may benefit the child and the family include social skills training, support groups and parenting skills training.  What is most important to remember is that each child’s situation is unique.  A child may present with ADHD and other concomitant issues, such anxiety, depression, learning disabilities.  Or, there may be family or environmental challenges.  Each child’s or adolescent's specific situation needs to be carefully considered when developing a comprehensive treatment plan. In addition, parents can help their child or adolescent manage their ADHD by open discussion, setting clear and consistent expectations and limits, helping them maintain a routine, encouraging activities where their child can succeed, and building self-esteem.

At OHEL we can help.
The diagnosis and treatment of ADHD in children and adolescents can be done by one of our licensed mental health professionals or by one of our licensed psychiatrists.  OHEL’s competent mental health professionals can provide the help needed to empower children, teens and their families impacted by ADHD and allow them to regain control and improve their quality of life.

Remember, at OHEL, we are only a phone call or a click away from your road to recovery.

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