This article is reprinted from the website of the National Mental Health Services Knowledge Exchange Network (KEN) from the Substance Abuse and Mental Health Services Administration's Center for Mental Health Services.
Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
This is one of a series of fact sheets on the mental, emotional, and behavior disorders that can appear in childhood or adolescence. The Center for Mental Health Services extends appreciation to the National Institute of Mental Health for contributing to the preparation of this fact sheet. Any questions or comments about its contents may be directed to the CMHS National Mental Health Services Knowledge Exchange Network (KEN)--see contact information below.
What Is Attention-Deficit/Hyperactivity Disorder?
Young people with attention-deficit/hyperactivity disorder typically are overactive, unable to pay attention, and impulsive. They also tend to be accident prone. Children or adolescents with attention- deficit/hyperactivity disorder may not do well in school or even fail, despite normal or above-normal intelligence. Attention- deficit/hyperactivity disorder is sometimes referred to as ADHD.
| In this fact sheet, "Mental Health Problems" for children and adolescents refers to the range of all diagnosable emotional, behavioral, and mental disorders. They include depression, attention-deficit/hyperactivity disorder, and anxiety, conduct, and eating disorders. Mental health problems affect one in every five young people at any given time. "Serious Emotional Disturbances" for children and adolescents refers to the above disorders when they severely disrupt daily functioning in home, school, or community. Serious emotional disturbances affect 1 in every 10 young people at any given time. |
What Are the Signs of Attention-Deficit/Hyperactivity Disorder?
There are actually three different
types of attention- deficit/hyperactivity disorder, each with different symptoms.
The types are referred to as inattentive, hyperactive-impulsive, and combined
attention-deficit/hyperactivity disorder.
Children with the inattentive type:
Children with the hyperactive-impulsive
type:
Combined attention-deficit/hyperactivity disorder, the most common type, is a combination of the inattentive and the hyperactive-impulsive types.
A diagnosis of one of the attention-deficit/hyperactivity disorders is made when a child has a number of the above symptoms, and the symptoms began before the age of 7 and lasted at least 6 months. Generally, symptoms have to be seen in at least two different settings (for example, at home and at school) before a diagnosis is made.
How Common Is Attention-Deficit/Hyperactivity
Disorder?
Attention-deficit/hyperactivity disorder is found in as many as 1 in every 20 children. Studies have shown that boys with attention-deficit/hyperactivity disorder outnumber girls with the disorder about three to one.**
Children and adolescents with attention-deficit/hyperactivity disorder are at risk for many other disorders. About half of all young people with attention-deficit/hyperactivity disorder also have oppositional or conduct disorder, and about a fourth have an anxiety disorder. As many as one-third have depression, and about one-fifth have a learning disability. Sometimes a child or adolescent will have two or more of these disorders in addition to attention-deficit/hyperactivity disorder. Also, children with attention-deficit/hyperactivity disorder are at risk for developing personality disorders and substance abuse disorders when they are adolescents or adults.
Attention-deficit/hyperactivity disorder is a major reason why children are referred for mental health care. Boys are more likely to be referred for treatment than girls, in part because many boys with attention-deficit/hyperactivity disorder also have conduct disorder. The mental health services and special education required by children and adolescents with attention-deficit/hyperactivity disorder cost millions of dollars each year. Underachievement and lost productivity can cost these young people and their families even more.
What Causes Attention-Deficit/Hyperactivity Disorder?
Many causes of attention-deficit/hyperactivity disorder have been studied, but no one cause seems to apply to all young people with the disorder. There is strong evidence that genetic factors are important. But other factors such as viruses, harmful chemicals in the environment, problems during pregnancy or delivery, or other things that impair brain development may play a role as well.
What Help Is Available for Families?
Many treatments-some with good scientific basis, some without-have been recommended for children and adolescents with attention-deficit/hyperactivity disorder. The best proven treatments are medication and behavior treatments.
Medication
The most widely used drugs for treating attention-deficit/hyperactivity disorder are stimulants, such as amphetamine (Dexedrine, Dextrostat, Desoxyn), methylphenidate (Ritalin), and pemoline (Cylert). Stimulants increase the activity in parts of the brain that are underactive in children and adolescents with attention-deficit/hyperactivity disorder. Experts believe that this is why stimulants improve attention and reduce impulsive, hyperactive, or aggressive behavior. Individuals may respond better to one medication than to another. For example, clonidine (Catapres) is often used, although its effectiveness has not been clearly shown. A few antidepressants may also work for some patients. Tranquilizers like thioridazine (Mellaril) have also been shown to work for some young people. Care must be used in prescribing and monitoring all medication.
Like most medications, those used to treat attention- deficit/hyperactivity disorder have side effects. When taking these medications, some children may lose weight, have a smaller appetite, and temporarily grow more slowly. Others may have trouble falling asleep. However, many doctors believe the benefits of medication outweigh the possible side effects. Side effects that do occur can often be handled by reducing the dosage.
Behavior Treatment
Behavior treatments include:
It is clear that both stimulants and behavior treatment can be helpful in the short run (a few weeks or months). However, it is not clear how long the benefit lasts. The Federal Government's National Institute of Mental Health is supporting research on the long-term benefits of various treatments as well as research to find out whether medication and behavior treatment are more effective when combined. There is also research on new medicines and other new treatments. Other Federal agencies carrying out research on attention-deficit/hyperactivity disorder include the Center for Mental Health Services and the Department of Education.
A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.
Tying together all the various supports and services in a plan of care for a particular child and family is commonly referred to as a "system of care." A system of care is designed to improve the child's ability to function in all areas of life-at home, at school, and in the community. For a fact sheet on systems of care, call 1.800.789.2647.
| In a "System of Care," local organizations work in teams-with families as critical partners-to provide a full range of services to children and adolescents with serious emotional disturbances. The team strives to meet the unique needs of each young person and his or her family in or near their home. These services should also address and respect the culture and ethnicity of the people they serve. (For more information on systems of care, call 1.800.789.2647.) |
Can Attention-Deficit/Hyperactivity Disorder Be Prevented?
Because there are so many suspected causes of attention- deficit/hyperactivity disorder, prevention may be difficult. However, it always is wise to obtain good prenatal care and stay away from alcohol, tobacco, and other harmful chemicals during pregnancy and to get good general health care for the child. These recommendations may be particularly important if attention-deficit/hyperactivity disorder is suspected in other family members. Knowing that attention- deficit/hyperactivity disorder is in the family can alert parents to take early action to prevent bigger problems.
What Else Can Parents Do?
When it comes to attention-deficit/hyperactivity disorder, parents and other caregivers should be careful not to jump to conclusions. A high energy level alone in a child or adolescent does not mean that he or she has attention-deficit/hyperactivity disorder. The diagnosis depends on whether the child or adolescent can focus well enough to complete tasks that suit his or her age and intelligence. This ability is most likely to be noticed by a teacher. Therefore, input from teachers should be taken seriously.
If parents or other caregivers suspect attention-deficit/hyperactivity disorder, they should:
It is important that people who are not satisfied with the mental health care they are receiving to discuss their concerns with the provider, to ask for information, and/or to seek help from other sources.
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Important Messages About Children's and Adolescents' Mental Health:
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1Prevalence of serious emotional disturbance in children and adolescents. Mental Health, United States, 1996. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1996.
**This estimate provides only a rough gauge of the prevalence rates (number of existing cases in a defined time period) for this disorder. The National Institute of Mental Health is currently engaged in a nationwide study to determine with greater accuracy the prevalence of mental disorders among children and adolescents. This information is needed to increase understanding of mental health problems and to improve the treatments and services that help young people who are affected by these conditions.
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