Attention deficit hyperactivity disorder (ADHD), sometimes referred to as attention deficit disorder (ADD), is a mental disorder in which an individual displays a pattern of age inappropriate hyperactivity, impulsivity, or inattention. The symptoms of ADHD must present themselves before the age of 12, and they must occur in multiple settings (e.g. at home and school, not just at home).
A meta-analysis of genetic studies found that ADHD is highly heritable (Gizer, Ficks, & Waldman, 2009). Environmental factors--such as the use of alcohol and tobacco during pregnancy (Burger et al., 2011; Abbott & Winzer-Serhan, 2012)--contribute to the presentation of ADHD, but genetics play a more prominent role. About 6 percent of people in the United States under the age of 18 meet the DSM-IV diagnostic criteria for ADHD, and males are about three times more likely to be diagnosed (Emond, Joyal, & Poissant, 2009; Willcutt, 2007)
Treatment for ADHD includes social interventions (psychotherapy, behavioral interventions, parent training, and education) and medication. Social interventions and medication can both be effective on their own, but a combination of the two modalities tends to be the most effective.
Psychotherapy and Behavioral Interventions
Behavioral interventions and psychotherapy have been found to be very effective for the treatment of mild ADHD symptoms (Kratochvil et al., 2009; National Institute for Health and Clinical Excellence, 2008).
In the treatment of children with ADHD, it is essential to include parents in the process. Children with ADHD are often unable to implement changes without consistent interventions from their caretaker. Parents can reduce the severity of their child's symptoms through the use of the following behavioral interventions:
Tips for Parents: Managing ADHD
- Establish a predictable daily routine.
- Set clear and realistic rules.
- Use rewards and punishments consistently.
- Ensure that your child is eating a healthy diet.
- Ensure at least 8 hours of sleep each night.
In addition to behavioral interventions, parents and children can benefit from education about ADHD. Many parents will have difficulty responding to their children with ADHD because they are under the impression that the child is intentionally being disrespectful or disruptive. Education about the biological causes and symptoms of ADHD can help reduce tension in parent-child relationships. It helps parents to know that their child isn't simply trying to be a nuisance, but that they have a physical limitation that makes it very difficult to control their behavior.
Children with ADHD can benefit from therapy focused on social skills training. Role-playing, modeling of good behavior, practicing conversation skills such as listening and waiting to speak, conflict management education, and emotional management skills can all help children reduce the impact of their symptoms.
Stimulants are the most common types of medication used in the treatment of ADHD. Specific drugs include Adderall, Ritalin, Vyvanse, Concerta, and Focalin.
Stimulants are typically the preferred medication for the treatment of ADHD, but alternatives such as atomoxetine may be used because of its lower potential for abuse. Stimulants can be addictive, and over time a user can develop tolerance which requires them to use more of the drug to achieve the same effect.
Medication has been found to be effective for about 80% of those with ADHD (Canadian ADHD Practice Guidelines, 2011), but there have been mixed findings regarding the long-term effects its use (Hazell, 2011). Medication can improve a child's ability to focus, control impulsive behavior, and decrease excessive motor behavior. That being said, they are not magic pills that make children behave well and become effective students. These abilities are better fostered through parenting skills.
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2. Burger, P. H., Goecke, T. W., Fasching, P. A., Moll, G., Heinrich, H., Beckmann, M. W., & Kornhuber, J. (2011). How does maternal alcohol consumption during pregnancy affect the development of attention deficit/hyperactivity syndrome in the child. Fortschritte der Neurologie-Psychiatrie, 79(9), 500-506.
3. Canadian ADHD Practice Guidelines. Canadian ADHD Alliance. Retrieved 4 February 2011.
4. Emond, V., Joyal, C., & Poissant, H. (2009). [Structural and functional neuroanatomy of attention-deficit hyperactivity disorder (ADHD)]. L'encéphale, 35(2), 107-114.
5. Gizer, I. R., Ficks, C., & Waldman, I. D. (2009). Candidate gene studies of ADHD: a meta-analytic review. Human genetics, 126(1), 51-90.
6. Hazell, P. (2011). The challenges to demonstrating long-term effects of psychostimulant treatment for attention-deficit/hyperactivity disorder. Current opinion in psychiatry, 24(4), 286-290.
7. Kratochvil, C. J., Vaughan, B. S., Barker, A., Corr, L., Wheeler, A., & Madaan, V. (2009). Review of pediatric attention deficit/hyperactivity disorder for the general psychiatrist. Psychiatric Clinics of North America, 32(1), 39-56.
8. National Institute for Health and Clinical Excellence (24 September 2008). "CG72 Attention deficit hyperactivity disorder (ADHD): full guideline" (PDF). NHS.
9. Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics, 9(3), 490-499.