Parenting a Child With Attention Deficit Hyperactivity Disorder (ADHD)
John Mersch, MD, FAAP
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- Childhood ADHD facts
- What are the signs and symptoms of childhood ADHD?
- What should parents do if they suspect their child has ADHD?
- What are the causes of childhood ADHD?
- What should parents of children with ADHD expect from their child?
- What treatment options exist for a child with ADHD?
- What are the risks of the use of stimulant medication and other treatments?
- What are other therapeutic approaches for children with ADHD?
- Is childhood ADHD on the rise?
- What is the outlook for a child with ADHD?
- What can parents of children with ADHD do to help themselves?
- Find a local Psychiatrist in your town
Childhood ADHD facts
Attention deficit hyperactivity disorder (ADHD) is a chronic behavioral condition that initially manifests in childhood and is characterized by problems of hyperactivity, impulsivity, and/or inattention. Not all patients manifest all three behavioral categories. These symptoms have been associated with difficulty in academic, emotional, and social functioning. The diagnosis is established by satisfying specific criteria. ADHD may be associated with other neurological, significant behavioral, and/or developmental/learning disabilities. Therapy combines the use of medication, behavioral therapy, and adjustments in day-to-day lifestyle activities. ADHD is one of the most common disorders of childhood. ADHD occurs more commonly in boys than girls. While previously believed to be "outgrown" by adulthood, current opinion indicates that many children will continue throughout life with symptoms that may affect both occupational and social functioning.
Historical figures of diverse backgrounds and accomplishment have demonstrated behavior compatible with ADHD. Mozart composed and remembered entire musical compositions but disliked the tedious task and attention to detail necessary when transcribing to paper. Einstein would spend hours and even days sitting quietly in a chair doing "thought experiments," including complex series of mathematical calculations and revisions. Ben Franklin failed in school due to his perfectionist and impulsive behaviors. He later mastered five languages (self-taught) and is highly respected as an author, scientist, inventor, and businessman (publisher).
What are the signs and symptoms of childhood ADHD?
The medical community recognizes three basic expressions of the disorder:
- Primarily inattentive: The child exhibits recurrent inattentiveness and an inability to maintain focus on tasks or activities. In the classroom, this may be the child who is "spacing out" and "can't stay on track."
- Primarily hyperactive-impulsive: Impulsive behaviors and inappropriate movement (fidgeting, inability to keep still) or restlessness are the primary problems. Unlike the inattentive ADHD-type child, this individual is more often the "class clown" or "class devil" -- either manifestation leads to recurrent disruptive problems.
- Combined: This is a combination of the inattentive and hyperactive-impulsive forms.
The combined type of ADHD is the most common. The predominantly inattentive type is being recognized more and more, especially in girls and in adults. The predominantly hyperactive-impulsive type, without significant attention problems, is rare.
In the United States, ADHD affects about 3%-10% of children. Similar rates have been reported in other developed countries such as Germany, New Zealand, and Canada.
- Usually, the abnormal behaviors are established by the time the child is about 7 years old. Rarely, ADHD is diagnosed in teenagers or young adults. Children with ADHD are often noted to be emotionally delayed, with some individuals having a delay in maturity of up to 30% when compared with their peers. Thus a 10-year-old student may behave like a 7-year-old, whereas a 20-year-old young adult may respond more like a 14-year-old teenager.
- Boys are more likely than girls to be diagnosed with ADHD. At one time, the ratio of boys to girls with ADHD was thought to be as high as 4:1 or 3:1. This ratio has been decreasing, however, as more is known about ADHD. For instance, greater recognition of the inattentive form of ADHD has increased the number of girls diagnosed with the disorder.
- Hyperactive symptoms may decrease with age, usually diminishing at puberty, perhaps due to gaining greater self-control as they mature.
- Inattention symptoms are less likely to fade with maturity and tend to remain constant into adulthood.
- People with ADHD are also more likely than the general population to have a family member with ADHD.
Since 1994, the establishment of the diagnosis of childhood ADHD has relied upon specific criteria outlined in the DSM IV. The guidelines emphasize that symptoms must be present for at least six months and generally were noted to be causing disruption of age-appropriate activity before 7 years of age. According to the criteria, such disruption should occur in at least two settings (such as home and school). In addition, these symptoms must not be better explained by another mental disorder (such as anxiety disorder).
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