You may have heard the terms ADD and ADHD used interchangeably. ADHD stands for attention deficit hyperactivity disorder. Previously, patients who exhibited attention deficit without hyperactivity were diagnosed as having attention deficit disorder or ADD. In 1987, the The American Psychiatric Association changed the diagnostic criteria of ADHD to include a subset of patients without hyperactivity, effectively making the ADD diagnosis obsolete. This article includes information on all forms of ADHD, including that which was previously referred to as ADD.
Attention-deficit/hyperactivity disorder (ADD/ADHD) is a neurodevelopmental disorder that impairs personal, social, academic, and/or occupational functioning. It often involves dysfunction in attention, memory, perception, language, problem-solving, or social interaction.
Onset is frequently by age 4 and invariably before age 12; the typical age of initial diagnosis is between 8 and 10 years of age. Children with ADHD may have trouble paying attention, controlling impulsive behaviors, or be overly active. They do not grow out of the normal childhood tendencies to have difficulty focusing and/or behaving. A child with ADHD might be prone to daydreaming, forgetting or losing things, fidgeting, talking too much, making careless mistakes or taking unnecessary risks. They may struggle with resisting temptation and/or have difficulty getting along with others.
There are three types of ADHD:
1. Predominantly Inattentive, which is categorized by the child having trouble organizing or staying on task, paying attention to detail, or following instructions or conversations. They are often easily distracted.
2. Predominantly Hyperactive-Impulsive, where the child fidgets and talks a lot, has difficulty sitting still, is constantly moving, feels restless, and struggles with impulsivity, such as interrupting, grabbing things from people, speaking at inappropriate times, or exhibiting an inability to wait his or her turn.
3. Combined Presentation, which shares symptoms of the first two types equally.
ADHD is about twice as common in boys, but the ratios vary by type. Behavioral history may reveal low frustration tolerance, opposition, aggressiveness, poor social skills and peer relationships, sleep disturbances, anxiety, depression, and mood swings, among other concerns. Boys tend to present on the hyperactive end of the spectrum, making their symptoms hard to miss. Girls, on the other hand, usually exhibit symptoms of inattention, which they can take great pains to cover up. Parents are encouraged to look for signs that their daughter is staying up late to finish homework or wanting to avoid school, two behaviors that can indicate she is unable to focus and may have ADHD.
To receive a diagnosis of ADHD, symptoms must be present for more than six months and be present before age 12. They must be more pronounced than expected for the child’s developmental level, occur in at least two settings (such as home and school) and interfere with normal day-to-day functioning.
The multi-step process to diagnose ADHD requires a medical exam, hearing and vision tests to rule out other problems with similar symptoms to ADHD, a checklist for rating symptoms of ADHD, and a history of the child from parents, teachers, and sometimes directly from the child.
Current research shows that genetics plays an important role in understanding the cause(s) of ADHD, which are largely unknown. Current studies focus on the role of dopamine, norepinephrine, and, most recently, serotonin neurotransmitters. Other possible causes being studied are brain injury/head trauma, exposure to environmental agents (such as lead) or alcohol/tobacco in utero (or at a young age), and premature delivery or low birth weight. Research does not support the popularly held view that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty.