ADHD (Attention Deficit-Hyperactive Disorder) is a common neurodevelopmental disorder that arises in early childhood during the brain development phase.
It is mainly genetic, resulting from multiple genes. However, environmental factors may magnify or even cause it. For example, prenatal exposure to cigarette smoking increases the incidence.
In the U.S. 7.2% of children have ADHD. About a third will outgrow it, but the rest still have it as adults. It is common for people with ADHD to have other neurodevelopmental disorders, e.g., a specific learning disorder such as dyslexia.
Boys are twice as likely to have ADHD than girls. Girls are more likely to have their ADHD missed because they often present differently.
Boys are more likely to have a primarily hyperactive-impulsive form, whereas girls typically have a primarily inattentive form. Significant hyperactivity tends to be more noticeable than being inattentive.
There are a wide range of symptoms besides the core features of hyperactivity, impulsiveness, and inattentiveness. They include being disorganized, losing things, making “careless” mistakes, easily distracted, interrupts others, clumsiness, easily angered, rarely sits still, poor followthrough, being messy, and they often have delays in language, motor, or social skills.
Children with ADHD are not to be expected to have all of these symptoms.
Regardless of which symptoms they have, they are not to be diagnosed as having ADHD unless their symptoms interfere with functioning or development.
Also, they must have symptoms in more than one setting. For example, it can’t be found only at home or only at school.
Because of inattentiveness they often do poorly in school. They may spend time daydreaming or doodling in the classroom.
This often results in teachers and parents thinking the child is intellectually impaired, but they may actually have a high IQ.
There is no biological test for ADHD but there are other tests that can help confirm the diagnosis if it is uncertain.
Treatment can include medication (stimulants and non-stimulant options), therapy by a child psychologist, and learning ways to compensate. For example, schools may provide reasonable accommodations such as allowing the child take exams by themselves.
Studying in a quiet environment without distractions is helpful. Color coding, using electronic devices to give reminders, giving only one directive at a time, and many other strategies are helpful.
A subset of children with ADHD benefit from certain dietary changes. However, it does not help many of them.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
