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Attention-deficit/hyperactivity disorder (ADHD)
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Attention-deficit/hyperactivity disorder (ADHD)

From MayoClinic.com

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Causes

Although the exact cause of ADHD isn't well understood, researchers have identified several factors that may play a role in the disorder:

  • Altered brain function. The parts of the brain that regulate attention, planning and motor control seem to be less active in children with ADHD. In addition, adults and children with ADHD appear to have low levels of dopamine — a brain chemical with a number of important functions. Among other things, dopamine sends messages to the part of the brain that controls movement, helps regulate attention and affects motivation. Some adults with ADHD have very low levels of the enzyme that produces dopamine (dopa decarboxylase). Other people with ADHD seem to have too many dopamine transporters, which remove dopamine after it is produced.

  • Heredity. ADHD tends to run in families. Most children with ADHD have at least one relative with the disorder, and approximately one-third of men with a history of ADHD have children who also have ADHD. Furthermore, when one identical twin has ADHD, the other twin almost always has the disorder as well.

  • Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke are at increased risk of having children with ADHD. And alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce dopamine. In addition, pregnant women who are exposed to environmental poisons such as dioxins and PCBs are more likely to have children with ADHD.

When to seek medical advice

Some experts believe this increase is due, at least in part, to the intense media coverage ADHD has received and to greater public awareness of the disorder.

The strong interest in ADHD likely means that more children with the disorder are receiving needed treatment. It may also mean, however, that children who don't have ADHD or who have other problems such as depression, anxiety, learning disabilities or sleep disorders are being diagnosed and treated incorrectly.

In general, if your child has trouble concentrating, sitting still or controlling his or her behavior, and these problems are creating significant difficulties at home and at school, see your pediatrician or family physician. Your doctor may later refer you to a specialist, such as a developmental-behavioral pediatrician, psychologist, psychiatrist or pediatric neurologist, but it's important to have a medical evaluation first to rule out other causes of your child's symptoms.

Although symptoms of ADHD can sometimes appear in preschoolers, diagnosing the disorder in very young children is extremely difficult. Often, developmental problems such as language delays and adjustment difficulties can be mistaken for ADHD. For that reason, preschoolers suspected of having ADHD are more likely to need evaluation by a subspecialist.

Children being treated with medication should see their doctor regularly — typically every 6 months. Your doctor may also recommend retesting every few years, depending on your child's grade level, age and diagnosis.

Call your physician if your child is taking medication for ADHD and experiences side effects, such as loss of appetite, trouble sleeping or increased irritability. Over time some children taking stimulant medications may also lose weight. This is another reason why follow-up visits are important.

Screening and diagnosis

No single test for ADHD exists, making the disorder difficult to diagnose. But a variety of exams can differentiate ADHD from learning disabilities and mood disorders. For this reason, make sure that the physician performing the evaluation is well trained and takes time to get background information from you and your child's teachers. Your physician should also make use of appropriate local resources for needed testing. The process usually requires at least two office visits.

Diagnosing ADHD in children

Assessing a child for ADHD usually begins with complete medical, school and family histories, and a medical exam to exclude other causes of your child's symptoms. A number of medical conditions may cause symptoms similar to those of ADHD, including learning disabilities, mood disturbances, seizure disorders, fetal alcohol syndrome, vision or hearing problems, and Tourette's syndrome — a neurologic disorder characterized by compulsive body movements and vocalizations.

Because ADHD symptoms may not be obvious in a doctor's office, your doctor may use teacher questionnaires to learn more about your child's behavior. He or she may also use ADHD-specific rating scales, such as the Connors Rating Scales and the Achenbach Child Behavior Checklist (CBCL), to help collect and evaluate information about your child.

An evaluation for ADHD should also include checking for other conditions such as learning or language problems, depression, anxiety and sleep disorders. These and other coexisting conditions are found in as many as one-third of children with ADHD. Sometimes your primary care doctor may refer your child to a psychologist or psychiatrist for further evaluation or treatment.

Most children won't need brain scans to evaluate for ADHD. Although brain changes have been noted in children with ADHD, these changes aren't a reliable way to diagnose the disorder. In addition, most experts caution against diagnosing ADHD based solely on a child's response to a psychostimulant medication.

Diagnosing ADHD in adults

Adult evaluation usually relies on interviews and extensive medical and behavioral histories. School and job records may provide clues to past behavior. Some specialists also use tests that objectively measure attentiveness and concentration.

Getting an accurate diagnosis

Many experts agree that ADHD is both underdiagnosed and overdiagnosed. In some areas of the country as many as 17 percent of children are being treated for ADHD. That's two to three times the estimated rate of ADHD in the general population. These children are typically white, male and from affluent families. This has led to concern among some public health officials that ADHD has become a fad diagnosis in certain communities.

On the other hand, ADHD may be underdiagnosed in black and Asian-American children or in children living in poor and rural areas, either because their families lack insurance coverage for medical evaluations or because of geographic, gender or racial biases.

Sleep disorders and ADHD

Diagnosing ADHD is further complicated because some children who are hyperactive or inattentive actually have sleep problems, not ADHD. Researchers have discovered that two sleep disorders in particular — snoring and sleep apnea — may lead to hyperactivity and inattention.

Sleep apnea is a potentially serious condition in which you stop and start breathing — sometimes dozens of times — during sleep. Researchers don't completely understand the link between sleep apnea and hyperactivity, but when children with sleep apnea are treated for the disorder, their hyperactivity often disappears completely.

Children with true ADHD usually don't experience sleep apnea, but they may have disturbances in their REM cycle — the dream stage of sleep — which may affect their behavior. If you have a child who is hyperactive and snores or who has trouble sleeping, a pediatric sleep specialist may be able to help.

Complications

As many as one-third of children with ADHD also have other psychological or developmental conditions, including:

  • Oppositional defiant disorder (ODD). Generally defined as a pattern of negative, defiant and hostile behavior toward authority figures, ODD tends to occur more frequently in children who are impulsive and hyperactive.

  • Depression. Depression may occur in both children and adults with ADHD. It's more likely to appear when there's a family history of depression.

  • Anxiety disorders. Anxiety disorders tend to occur fairly often in children with ADHD and may cause overwhelming worry and nervousness as well as physical signs and symptoms, such as a rapid heartbeat, sweating and dizziness. Although anxiety disorders can cause severe symptoms, most people can be helped with therapy or medication.

  • Learning disabilities. Children with both ADHD and learning disabilities are the children most in need of special education services.

  • Tourette's syndrome. Many children with ADHD are at increased risk of Tourette's syndrome, a neurologic disorder characterized by compulsive muscular or vocal tics.

In addition to conditions that may occur with ADHD, the disorder itself can make life difficult for both children and adults. Children often struggle in the classroom, which can lead to academic failure and ridicule from both other children and adults. Although ADHD doesn't affect intelligence, most ADHD children are underachievers in school and many have been held back at least one grade. They are also more likely to drop out of school than are children who don't have ADHD. These problems are likely related to poor organizational skills, lack of attention and hyperactivity. As a result, children with ADHD often endure an ongoing cycle of ostracism and punishment for behavior they can't control.

In addition, children with ADHD are much more likely to experience minor trauma, such as fractures and lacerations, than are other children. And teenagers and adults with the disorder are far more likely to be involved in car accidents. In fact, people with ADHD tend to have more accidents and injuries of all kinds than do those who don't have the disorder.

ADHD has been associated with an increased risk of alcohol and drug abuse and delinquency. Some studies suggest that this is more likely to occur in people who have emotional problems in addition to ADHD.

Adults with ADHD are at increased risk of marital stress and divorce. Often, these adults didn't have the condition diagnosed as children and may have spent their lives struggling to understand their own behavior. In fact, many adults don't realize they have ADHD until a child or grandchild receives a diagnosis of the condition.

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This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.
In no event will The DrEddyClinic.com be liable for any decision made or action taken in reliance upon the information provided through this web site.

 


 



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Last Modified : 03/14/08 06:56 PM