Attention Deficit Hyperactivity Disorder (ADHD)

Topic Overview

What is attention deficit hyperactivity disorder (ADHD)?

Attention deficit hyperactivity disorder (ADHD) is a condition in which a person has trouble paying attention and focusing on tasks, tends to act without thinking, and has trouble sitting still. It may begin in early childhood and can continue into adulthood. Without treatment, ADHD can cause problems at home, school, work, and with relationships. In the past, ADHD was called attention deficit disorder (ADD).

What causes ADHD?

The exact cause is not clear, but ADHD tends to run in families.

What are the symptoms?

The three types of ADHD symptoms include:

• Trouble paying attention. People with ADHD are easily distracted and have a hard time focusing on any one task.
• Trouble sitting still for even a short time. This is called hyperactivity. Children with ADHD may squirm, fidget, or run around at the wrong times. Teens and adults often feel restless and fidgety and are not able to enjoy reading or other quiet activities.
• Acting before thinking. People with ADHD may talk too loud, laugh too loud, or become angrier than the situation calls for. Children may not be able to wait for their turn or to share. This makes it hard for them to play with other children. Teens and adults seem to "leap before they look." They may make quick decisions that have a long-term impact on their lives. They may spend too much money or change jobs often.

How is ADHD diagnosed?

ADHD is often diagnosed when a child is between 6 and 12 years old. Teachers may notice symptoms in children who are in this age group.

First, the child will have a physical exam to make sure that he or she does not have other problems such as learning disabilities, depression, or anxiety disorder. The doctor will use guidelines from the American Psychiatric Association to diagnose ADHD. The doctor may also look at written reports about the child's behavior. Parents, teachers, and others who have regular contact with the child prepare these reports.

How is it treated?

There is no cure for ADHD, but treatment may help control the symptoms. Treatment may include medicines and behavior therapy. Parents and other adults need to closely watch children after they begin to take medicines for ADHD. The medicines may cause side effects such as loss of appetite, headaches or stomachaches, tics or twitches, and problems sleeping. Side effects usually get better after a few weeks. If they don't, the doctor can lower the dose.

Therapy focuses on making changes in the environment to improve the child's behavior. Often, counseling and extra support at home and at school help children succeed at school and feel better about themselves.

How does ADHD affect adults?

Many adults don't realize that they have ADHD until their children are diagnosed. Then they begin to notice their own symptoms. Adults with ADHD may find it hard to focus, organize, and finish tasks. They often forget things. But they also often are very creative and curious. They love to ask questions and keep learning. Some adults with ADHD learn to manage their lives and find careers that let them use those strengths.

But many adults have trouble at home and work. As a group, adults with ADHD have higher divorce rates. They also are more likely to smoke and have more substance abuse problems than adults without ADHD. Fewer adults with ADHD enter college, and fewer graduate. Treatment with medicine, counseling, and behavior therapy can help adults with ADHD.

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Cause

The exact cause of attention deficit hyperactivity disorder (ADHD) is not known. But inherited genetic factors are likely responsible. Ongoing research is focused on identifying genes that cause a person to be susceptible to ADHD.

Using various imaging tests, researchers have been able to observe the brain at work. They have found a possible link between ADHD and:

• Brain structure.
• The function of chemicals in the brain that help regulate attention and activity (dopamine and norepinephrine).
• Differences in function of some of the areas of the brain that affect attention and impulse control.

Also, research shows that a mother's use of cigarettes, alcohol, or other drugs during pregnancy may increase the risk for ADHD. Some studies suggest that exposure to lead may cause symptoms associated with ADHD.¹

Although many parents believe that foods with sugar and food additives make their children more hyperactive, these foods have not been shown to cause ADHD. In a comprehensive review of research, the U.S. National Institutes of Health (NIH) found that restricted diets seemed to help only about 5% of children with ADHD, mostly either young children or children with food allergies. Other research has shown that sugar is not related to ADHD.¹

A study by the National Institute of Mental Health found that certain parts of the brains of children with ADHD develop normally but about 3 years later than in children without ADHD.² This may be why some children seem to grow out of the disorder.

Some people have misconceptions about ADHD, such as that children with ADHD are lazy or dumb. Talk with a doctor about questions or concerns you have about these issues.

Symptoms

The symptoms of attention deficit hyperactivity disorder (ADHD) may include:

• Inattention, which is having a short attention span and being easily distracted.
• Impulsivity, which can cause a person to do dangerous or unwise things without thinking about the consequences.
• Hyperactivity, which is inappropriate or excessive activity.

These symptoms affect people in all age groups who have ADHD. But typical behavior varies by age.

• In preschool-age children, symptoms may be hard to identify. Normal behavior in young children periodically includes all of the major symptoms. ADHD is distinguished from normal behavior by the severity and consistency of symptoms.
• Children between the ages of 6 and 12 usually show more obvious signs of ADHD than other age groups. School expectations can make symptoms more noticeable. For some children, school is the first setting where academic performance and socialization abilities are assessed. But it often is more difficult to detect ADHD when inattention is the primary symptom and the child is otherwise well-behaved. The presence of ADHD may be indicated by:
  • Low grades or test scores, including achievement tests.
  • Poor organization and study skills.
  • Socialization problems and feeling rejected by peers.
  • Dislike of school and frustration with school work.
• Teens between the ages of 13 and 18 may be in better control of disruptive behavior related to hyperactivity. Other problems that began in earlier years may continue or become worse when ADHD is not treated. Teens with inattention problems who previously managed to cope may start to fall behind in schoolwork. This is especially true when major changes occur, such as starting at a new school or going to college.
• Symptoms of ADHD in adults may not be as noticeable. Many adults with ADHD have not been diagnosed and treated. They can develop problems such as depression and difficulty maintaining a job.

There are several other conditions with symptoms similar to ADHD. For example, sometimes bipolar disorder and ADHD can be confused. It can be difficult to determine whether symptoms are caused by ADHD, another condition, or both.

What Happens

Preschool age

Normally, children 3 to 4 years of age are often inattentive, hyperactive, and impulsive-all the symptoms of attention deficit hyperactivity disorder (ADHD). Differentiating between what is normal for the age and what may be caused by ADHD can be difficult in children this young.

School-age and teen years

ADHD is most often diagnosed in children between ages 6 and 12. After a child starts school, the symptoms of ADHD become more noticeable. During this period, ADHD can disrupt many aspects of a child's life. Learning and academic performance, adjusting to change, sleeping, and getting along with others are all potential problem areas.

Symptoms of ADHD usually remain the same through early adolescence. Approximately 60% to 85% of children with ADHD continue to have symptoms into the teen years.³ Children with ADHD are often described as less mature than their peers and may lag behind in reaching milestones typical for the age group.

But some symptoms typically improve or become less obvious. For example, someone who had very disruptive hyperactive behavior during elementary school may only fidget or feel restless in high school.

Teens with ADHD have more problems when they are driving cars. They get more speeding tickets and have serious car accidents more often. They should be monitored closely by a licensed adult when they are learning to drive.

Adults

Symptoms of ADHD can last into adulthood and include difficulty focusing, organizing, and finishing tasks. But adults often are able to adjust in the workplace better than they did in the classroom as children.

Many adults do not realize that they have ADHD until their children are diagnosed and they begin to recognize their own symptoms. Some adults with ADHD learn to manage their lives and find careers in which they can use their strengths-intellectual curiosity and creativity-to their advantage. But many adults have difficulties at home and work. As a group, adults with ADHD have higher divorce rates, are more likely to smoke, and have more substance abuse problems than adults without the disorder. Also compared with their peers, fewer enter college and fewer graduate. Treatment with medicine, counseling, and behavioral therapies can be helpful.⁴

Effects on family

Raising a child who has ADHD can be a challenge. Parents must consistently monitor their child and respond to problem behavior appropriately. If other issues are causing stress within a family (such as divorce, violence, or drug or alcohol abuse), it may be even more difficult to deal with a child who has ADHD.

Conditions that often accompany ADHD

There is mounting evidence that people with ADHD commonly have one or more other disorders such as dyslexia, oppositional defiant disorder, conduct disorder, anxiety, and depression.

Treatment for ADHD can help control symptoms, allowing a child to grow and develop normally. Treatment also can decrease the frustration, discouragement, and failure that many people with ADHD experience throughout their lives.

What Increases Your Risk

So far, it appears that the greatest risk factor for developing attention deficit hyperactivity disorder (ADHD) is having an inherited tendency for the condition.

Environmental factors, such as certain parenting techniques, may influence how symptoms of ADHD are expressed, but these do not cause ADHD.

A stressful family situation may contribute to a child's symptoms. A child may feel guilty because of his or her symptoms and the problems they cause, which can increase the risk of developing another condition, such as anxiety, along with ADHD.

When To Call a Doctor

Call a doctor if:

• You notice that you or your child has symptoms of attention deficit hyperactivity disorder (ADHD) that began before age 7.
• Your child is showing signs of ADHD, such as inattention, impulsivity, and/or hyperactivity, that are causing problems at home or school. Parents and teachers often notice this behavior during the child's first few years in school.
• Your child shows signs of other mental health disorders, such as depression or anxiety, that last more than a few weeks or seem to be getting worse.
• Your child is having academic or behavioral problems at school.

Watchful Waiting

Preschool children

For young children who show signs of attention deficit hyperactivity disorder, watchful waiting is appropriate. It is difficult to diagnose ADHD in children younger than age 5. Young children generally have short attention spans, and their normal range of behavior includes periods of high activity and impulsivity. If you notice any ADHD symptoms in your preschooler that do not seem age-appropriate, work with your child to improve behavior. Keep a record of your child's behavior for 6 months to see if it improves. If it continues or has consequences, such as being expelled from day care or preschool, talk with your doctor about having your child evaluated.

School-age and teen years

Watchful waiting is not appropriate for school-age children and teens with ADHD symptoms. Children need attention from a doctor if they have behavior problems that occur in more than one setting, such as poor relationships with parents and poor academic performance.

Problems caused by inattention may not become significant until the teen years, when greater self-reliance is expected. A change in school (such as advancing to junior high or high school) or a new environment (such as moving to another city) can trigger problems with inattention. If you think your child may have an inattention problem, see a doctor to find out if ADHD is the cause.

Adults

Watchful waiting may not be appropriate if you are an adult and think that you may have ADHD. Consider how long you have experienced symptoms, and think about any major changes or difficult situations that are affecting your life. Your symptoms may improve when you have addressed and worked on those issues. But talk to a doctor if your symptoms concern you. If you have other symptoms, such as depression or anxiety, a doctor can help diagnose and treat your problems.

Who To See

Health professionals who can diagnose and treat attention deficit hyperactivity disorder (ADHD) with medicine include:

• Family medicine doctors.
• Pediatricians (may specialize in developmental problems).
• Psychiatrists (may specialize in adults or children and adolescents).
• Neurologists (may specialize in child or adult nervous systems).
• Nurse practitioners who specialize in psychiatry.

Health professionals who do not prescribe medicines but can provide behavioral therapy or family counseling include:

• Psychologists. Psychologists also frequently diagnose ADHD.
• Behavioral specialists.
• Social workers.
• Psychiatric nurse specialists.
• Licensed professional counselors.
• Family therapists.

Ask your health professional about his or her training and experience related to ADHD. Diagnosing and treating ADHD requires an ability to identify and distinguish behaviors that can be subtle and complicated. In addition, make sure your health professional has enough time to evaluate you or your child. Accurate diagnosis and successful treatment of ADHD takes repeated office visits and observations. It is also necessary that your health professional be able to coordinate between other health professionals, family members, teachers, and caregivers.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

The American Psychiatric Association (APA) has established the symptoms and criteria for diagnosing attention deficit hyperactivity disorder (ADHD). These criteria divide the condition into three basic types based on major symptoms⁵:

• ADHD, predominantly inattentive type
• ADHD, predominantly hyperactive-impulsive type
• ADHD, combined type

In addition, some people are diagnosed with "ADHD, not otherwise specified" when symptoms of inattention, hyperactivity, and/or impulsivity are present but do not fit into one of the three types.

A doctor will use criteria for diagnosing attention deficit hyperactivity disorders to determine whether a child has ADHD. Information used to diagnose the condition includes:

• An interview with the child.
• Medical history, including asking a parent about the child's social, emotional, educational, and behavioral history.
• Physical exam.
• Behavior rating scales or checklists for ADHD, used by parents and teachers to evaluate the child's symptoms.

It can be difficult to determine whether a child's behavior problems are caused by ADHD, other conditions with similar symptoms, or a combination of ADHD and another condition. Several verbal and written tests for associated disorders are used to help with this determination.

In addition, children with ADHD may have difficulty learning to read, write, or do math problems. Testing for learning disabilities will help teachers develop the best educational plan for a child with these difficulties.

Other tests may be done to identify other medical problems that might explain the child's symptoms, such as:

• Hearing or vision impairment. This type of disability often interferes with school achievement.
• Lead exposure. Children who have even small amounts of lead in their bodies can have symptoms similar to ADHD.
• Low red blood cell counts (anemia). This condition can cause low energy and poor concentration. It can be diagnosed with results from a complete blood count (CBC).
• Thyroid disease. Blood tests can help find out if a person has too much or too little thyroid hormone, which also can affect energy and attention. This is more common in adults than children.
• Seizures. Seizures can affect brain function and result in unusual behavior. In rare cases, a person with ADHD symptoms may have an electroencephalogram (EEG) to find out if seizures are occurring.

Parents often question whether ADHD is overdiagnosed. Many doctors and researchers believe that the increase in ADHD diagnoses results from improved detection techniques, especially the standardization of assessment criteria. Current and future research should help in answering this question.

Many adults with ADHD have never been diagnosed or treated. ADHD is a lifelong condition that, left untreated, can lead to low self-esteem, frustration, school or job failure, drug abuse, and depression. To diagnose ADHD in an adult, a doctor may use the Wender Utah Rating Scale (WURS), a written test that consists of 25 questions about childhood difficulties that are often seen with the condition. The scale evaluates the presence and severity of ADHD symptoms during childhood.

Adults with untreated ADHD are at an increased risk of abusing drugs or alcohol.⁴ If an adult is suspected of having or is diagnosed with ADHD, he or she may also be screened for alcohol and drug abuse.

Early Detection

The American Academy of Pediatrics guidelines recommend that doctors ask parents about behavior and school performance during regularly scheduled well-child visits. This helps identify early signs of ADHD. If you are concerned about how your child's temperament, learning skills, or behavior is developing, talk with your doctor during your next visit.

Before meeting with your doctor, think about at what age your child's symptoms began. In addition, you and other caregivers should record when the behavior occurs and how long it lasts. An important component of evaluation for ADHD is considering the kinds of problems that result from the behaviors and to what extent they affect academic performance and social behavior.

Some adults do not recognize their own symptoms of ADHD until their child is diagnosed with the condition. If your child is diagnosed with ADHD or you think you have symptoms, talk with your doctor about being screened for ADHD.

Treatment Overview

Initial treatment

Successful treatment of attention deficit hyperactivity disorder (ADHD) begins with an accurate diagnosis and understanding of a child's weaknesses and strengths. Learning about ADHD will help you and your child's siblings better understand how to help your child.

The American Academy of Pediatrics guidelines recommend medicine and/or behavior therapy to treat children with ADHD. This recommendation is based on numerous studies, including the landmark Multimodal Treatment Study of Children with ADHD (MTA), funded by the U.S. National Institute of Mental Health (NIMH). In this large study, researchers found that school-age children with ADHD who received stimulant medicine had a significant decrease in core ADHD symptoms (inattention, impulsivity, and hyperactivity).⁶

Your child's doctor may recommend that your child take a stimulant medicine, such as amphetamine (for example, Dexedrine, Adderall) or methylphenidate (for example, Ritalin, Concerta, Metadate CD). These medicines improve symptoms in about 70% of children who have the condition.⁷

Although it may seem contradictory, stimulants usually decrease hyperactivity and impulsivity and improve focus. Some parents worry about their children becoming addicted to stimulants. Research has shown that these medicines, when taken correctly, do not cause dependence. But parents should closely supervise the use of ADHD medicines, because abuse by siblings, classmates, and adults has been reported.

Parents are also often concerned about medicine side effects, including loss of appetite, nervousness, tics or twitches, and problems sleeping. Children should be closely monitored after they start medicines, to assess whether they are receiving the correct dose. These side effects usually decrease after a few weeks on the medicines, or the dosage can be lowered to offset side effects. For more information, see:

Should my child take medicines for ADHD?

Atomoxetine (Strattera) is a nonstimulant medicine that may be prescribed if stimulant medicines are not effective or have bothersome side effects. Strattera is not a controlled drug, which means refills on prescriptions and telephone prescriptions are allowed.

The AAP guidelines also encourage behavior therapy. Through behavior therapy, parents learn strategies, such as positive reinforcement, to improve a child's behaviors. Children learn to develop problem solving, communication, and self-advocacy skills. Behavior therapy is more helpful when used with medicine than it is when used by itself.

Counseling may help children and adults with ADHD recognize problem behaviors and learn ways to deal with them. For both parents and children, counseling can be a place to air frustrations and deal with stress.

Some children with ADHD also have other conditions, such as anxiety or oppositional defiant disorder. Behavioral therapy can help treat some of these conditions.⁷

Elementary school teachers are often the first to recognize ADHD symptoms because in the classroom more demands are placed on children to sit still, pay attention, listen, and follow class rules. Many times teachers recommend to parents that a child be tested or see a health professional.

Most children with ADHD qualify for educational services within the public schools. If your child qualifies, you will meet with school personnel to identify goals and establish an individualized education program (IEP). IEPs are based on the evaluation of a child's disability and his or her specific needs. This usually means your school will try to accommodate your child's extra needs, which may be as minor as placing him or her at the front of the class or as involved as providing classroom staff to assist your child.

Your doctor will talk with you about setting realistic and measurable goals for your child's behavior at school and at home. Each child must be considered individually, taking into account his or her specific problems and needs.

If your child is preschool age, your doctor may encourage behavioral therapy in an effort to curb symptoms and avoid using medicine at an early age. But if behavioral therapy is not effective in controlling symptoms, some doctors recommend medicines. Whether preschool-age children should receive medicine is somewhat controversial, because there are few studies in this age group. But the recently completed Preschool ADHD Treatment Study (PATS) has shown that the stimulant medicine methylphenidate (such as Ritalin) is safe and effective for preschool-age children.⁸

Recent research

• Although short-term studies have shown that stimulant medicines are safe, long-term effects have not been studied. In a recent 3-year study, children who took stimulant medicine grew almost 0.5 in. (1.3 cm) a year slower than children not on medicine. The study followed 540 youngsters with ADHD who were ages 7 to 9 at the start of the study. More studies are needed to determine whether growth is affected at other ages (younger than age 7, older than age 9) or whether children taking these medicines might catch up over a period of time.^{9, 10} As with any medicine, parents should think about not only the benefits their child might receive from these medicines but also the potential risks.
• In another part of the study, children who received medicine and behavior therapy did not have significantly greater improvement in core symptoms than those taking medicine only. But these children had some improvements in other areas, including less anxiety, better academic performance, and improved parent-child relations and social skills.¹¹
• The study also looked at children who had ADHD in addition to another condition, such as conduct disorder or anxiety. Children who had ADHD and anxiety benefited from a combination of both medicine and behavior therapy.¹²

Ongoing treatment

Regular communication among parents, teachers, and doctors benefits a child who has attention deficit hyperactivity disorder (ADHD).

Teens will benefit from continuing to take a stimulant medicine-such as amphetamine (for example, Dexedrine, Adderall) or methylphenidate (for example, Ritalin, Concerta, Metadate CD, Focalin)-or nonstimulant atomoxetine (Strattera) if either type of medicine has been helpful in the past.

Parents can also be reassured that taking stimulant medicine for ADHD does not increase the risk for substance abuse later. In fact, a recent analysis that followed children and teens with ADHD for at least 4 years found less alcohol and drug abuse in those who had taken stimulant medicines than in those who did not receive medicine.¹³ For more information, see:

Should my child take medicines for ADHD?

Staying closely involved with your teen and continuing behavior therapy takes a lot of hard work but may pay off in the long run. The teen years present many challenges, including increased schoolwork and the need to be more attentive and organized. Making good decisions becomes especially important during these years when peer pressure, emerging sexuality, and other issues surface. Use consequences that are meaningful to your teenager, such as losing privileges or having increased chore assignments. Parents and teens can work together to establish reasonable, obtainable goals and negotiate appropriate rewards when those goals are met.

ADHD in adulthood

Attention deficit hyperactivity disorder (ADHD) often goes undiagnosed in adults. The right treatment can help those who have struggled with the condition for years. Like ADHD in children, adults may benefit from medicine combined with psychological support, including education about the disorder, support groups and/or counseling, and skills training. Skills training can include time management, organizational techniques, and academic and vocational counseling.

Studies have found that about 58% of adults who have ADHD report a better ability to focus and less hyperactivity and impulsivity when taking stimulant medicines.¹⁴ If stimulant medicines have bothersome side effects or are not effective, your doctor might recommend atomoxetine (Strattera), a nonstimulant medicine. Strattera is not a controlled drug, which means refills and telephone prescriptions are allowed.

Certain antidepressants, such as bupropion (for instance, Wellbutrin) or tricyclics (for example, imipramine, nortriptyline, desipramine), are sometimes also recommended for adults with ADHD.

What To Think About

The U.S. Food and Drug Administration (FDA) has issued an advisory on Strattera. It suggests parents and other caregivers closely watch for warning signs of suicide in children and teens taking this medicine.¹⁵ The FDA does not recommend that people stop using this medicine. Instead, people who use this medicine should be watched for warning signs of suicide.

There are several myths that can interfere with a realistic perception of ADHD. It is important to understand that ADHD is a medical condition that cannot be consistently controlled without treatment. Help your child with ADHD to learn about the condition and the importance of following treatment plans. Your child is more likely to successfully control symptoms when he or she actively participates in treatment, such as taking medicines on time.

Some people use treatment methods that have not been proved helpful, such as diet restrictions. Do not substitute these practices for conventional medical treatment. Some treatments are potentially physically and emotionally harmful or unproved. Using them not only can be dangerous but may also prevent you from using proven methods of treatment. Talk with a doctor about the concerns or questions you or your child has about ADHD or its treatment.

Prevention

There is no known way to prevent attention deficit hyperactivity disorder (ADHD). Avoiding alcohol, drugs, and smoking during pregnancy may help prevent a child from developing behavior similar to ADHD as well as many other health problems.

Although you cannot prevent ADHD, you can help your child have fewer learning and attention problems by:

• Having good medical care and practicing healthy habits during pregnancy.
• Learning and applying good parenting skills, including setting consistent behavior limits.
• Maximizing preschool learning and attention skills by reading to your child and providing new learning experiences such as puzzles and board games. The development of attention skills can be increased with these types of activities rather than by watching television.

In addition, nurturing techniques that begin at birth and continue throughout childhood will help your child reach his or her potential regardless of whether ADHD is a concern.

Home Treatment

Many home treatment methods can help reduce your child's symptoms of attention deficit hyperactivity disorder (ADHD) symptoms. The approaches differ for children and adults, but treatment for all ages emphasizes understanding the condition, establishing daily structure, and using support systems.

When your child has ADHD, work together to improve behavior and functioning at home and school. In addition, it is important for you to recognize that helping yourself will also help your child.

Tips for self-care

• Take care of yourself. It is often challenging to raise a child with ADHD. Caring for your own physical and mental health is an important part of helping your child and will help provide the needed energy.
• Educate yourself about ADHD. Learn as much as you can about the condition and your child's specific symptoms. You will be better able to help your child if you understand the condition.
• Learn behavior management skills. Children usually need help learning how to interact appropriately with other people. You can help your child by learning behavior management skills. An important component of behavior management is establishing natural and logical consequences for misbehavior.

Tips for your child

Helping your child build self-esteem. Behaviors caused by ADHD can affect a child's feelings about himself or herself. You can help your child develop healthy self-esteem by encouraging a sense of belonging, confidence in learning, and an awareness of his or her contributions.

Helping your child get the most out of school. The symptoms of ADHD can interfere with a child's ability to succeed in school. Promoting school success will help your child academically, socially, and developmentally.

Helping your child get things done. Children with ADHD have more difficulty than other children in paying attention to instructions, and they frequently get distracted before they can complete a task. Your patience, persistence, and creative thinking can help your child learn skills and accomplish tasks at home and school.

Medications

Medicines are used to help control the symptoms of attention deficit hyperactivity disorder (ADHD): hyperactivity, impulsivity, and inattention.

Most often, stimulant medicines are used to treat ADHD. These medicines are effective for people of all ages, although more research is needed on how adults respond. In general, stimulant medicines improve symptoms in about 70% of people who have ADHD.⁷ There are often quick and dramatic improvements in behavior.

Other types of medicines may be used to treat ADHD.

• Atomoxetine (Strattera) is a nonstimulant medicine for ADHD.
• Some antihypertensives, designed to treat high blood pressure, can also help control aggressive and impulsive behaviors in some people.
• The antidepressant bupropion or a tricyclic antidepressant may be needed if psychostimulants do not improve symptoms.

Medicine may be needed to treat other mental health conditions, such as anxiety disorders, that often occur along with ADHD.

If you are giving your child medicine for ADHD, it is important to make sure it is taken consistently. In addition, you will need to regularly monitor the effects of the medicine and communicate closely with your child's doctor.

For more information, see:

Should my child take medicines for ADHD?

Medication Choices

The following medicines are used to treat attention deficit hyperactivity disorder (ADHD):

• Stimulants, such as Ritalin, Concerta, Metadate CD, Focalin, Dexedrine, Adderall, and Daytrana
• Atomoxetine (Strattera), an approved nonstimulant medicine for children, teens, and adults with ADHD

• Antihypertensives, such as Catapres and Tenex, which may be used to treat aggression and impulsivity not controlled by ADHD medicines
• Antidepressants, such as bupropion (for example, Wellbutrin)

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on Strattera. It suggests parents and other caregivers closely watch for warning signs of suicide in children and teens taking this medicine.¹⁵
• An advisory on antidepressants to closely monitor adults, teens, and children taking this medicine for warning signs of suicide.

The FDA does not recommend that people stop using these medicines. Instead, a person taking these medicines should be watched for warning signs of suicide.

All medicines approved for the treatment of ADHD come with an FDA warning about possible heart-related or mental health problems. Before starting a medicine for ADHD, tell your doctor if you or your child has any heart problems, heart defects, or mental health problems.

What To Think About

All of a child's behavior problems may not be controlled by medicine for ADHD. The child may still have a higher level of some behavior problems than other children the same age. In addition, it has not been established that medicine improves the long-term educational, occupational, and social functioning of a person who has ADHD.

New longer-acting medicines allow many people to take one pill a day for their ADHD symptoms, avoiding the multiple dosages that were standard in the past.

Although short-term studies have shown stimulant medicines are safe, long-term effects have not been studied. In a recent 3-year study, children who took stimulant medicine grew almost 0.5 in. (1.3 cm) a year slower than those children not on medicine. The study followed 540 youngsters with ADHD who were ages 7 to 9 at the start of the study. More studies are needed to find out if growth is affected at other ages (younger than age 7, older than age 9) or whether children taking these medicines might catch up over a period of time.^{9, 10} As with any medicine, parents should think about not only the benefits their child might receive from these medicines but also the potential risks.

Most medicines to treat ADHD are approved by the FDA for children age 3 and older. But there are few studies on the use of ADHD medicine for children age 5 and younger. Most doctors do not prescribe medicines for a child who has ADHD symptoms until he or she starts school. Younger children are more likely to have side effects from medicines. But they may be prescribed for younger children when symptoms severely affect a child's behavior and quality of life.

Some medicines used to treat ADHD (such as stimulants) can be abused. Make sure your child knows not to sell or give medicine to other people. An adult should supervise the medicine.

Surgery

There is no surgical treatment for attention deficit hyperactivity disorder (ADHD).

Other Treatment

Other methods of treatment that may be used for attention deficit hyperactivity disorder include behavior management, social skills training, and counseling.

Treatment for ADHD is based on your or your child's symptoms and problem behaviors. Medicine is the most effective treatment for the major ADHD symptoms of inattention, impulsivity, and hyperactivity. Other treatment is sometimes recommended if:

• Symptoms are mild.
• Symptoms do not respond to medicine.
• Medicines cause significant side effects.
• Another condition, such as anxiety, occurs along with ADHD. Medicine combined with other treatment often is used.

Other Treatment Choices

Behavioral interventions

Behavioral interventions help train parents, teachers, and other adults responsible for a child with ADHD. Programs emphasize the need to establish routines and rules for behavior and to closely monitor how a child responds. The adult consistently delivers rewards or consequences depending upon how the child complies with the rules. This type of treatment has been shown to be more effective than cognitive-behavioral therapy techniques. Cognitive-based therapies depend more upon the child to self-direct behavioral changes.⁷ A child with ADHD is not likely to have the skills to change his or her behavior without help and guidance from adults.

Behavioral interventions most often used to help treat ADHD in a child include:

• Behavior management. Time-out and reward systems can help a child with ADHD learn appropriate behaviors for the classroom and home. Parent training in behavior management skills is conducted during a series of 6 to 12 counseling sessions of 1 to 2 hours a week.
• Social skills training. These techniques help the child learn to be less aggressive and impulsive, manage anger, and behave in a more socially acceptable way.
• Counseling, including family therapy. All household members can benefit from learning methods to deal effectively with ADHD behavior.

Behavioral intervention for adults focuses upon assistance with organizational skills and healthy relationships.

Complementary and alternative medicine

Complementary and alternative medicine is used by some therapists or others who do not operate within mainstream medical practice. But none of these complementary therapies have been shown through clinical research to be effective in treating ADHD and should not replace proven conventional methods. More research is needed before any can be recommended as primary treatment for ADHD.¹⁶ But a person with ADHD may benefit from safe, nontraditional therapies used in addition to conventional medical treatment. For example, acupuncture or biofeedback may help relieve stress and muscle tension and improve a person's overall well-being and quality of life.

If you are considering using complementary and alternative medicine to help treat ADHD, be open with your doctor about the subject. He or she can help direct you to treatments that are safe to use in combination with proven techniques. Only those treatments that best help control ADHD symptoms without causing physical or emotional harm should be used.

What To Think About

Overall, medicines are the most effective treatment for ADHD, although individuals vary in their response to medicine. Behavioral training, training and education for parents, and counseling are sometimes used as the primary treatment for mild symptoms. Usually, these methods are used in addition to medicine for people with moderate to severe symptoms.

Parents may understandably be reluctant to give their child medicine. But studies show that for short-term use, these medicines are safe and can positively affect behavior and improve the quality of life for people with ADHD and for their families. It is important to talk openly with your doctor about any concerns in order to best understand and treat ADHD.

Other Places To Get Help

Books

Online Resource

Organizations

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References

Citations

1. National Institute of Mental Health (2003). Attention Deficit Hyperactivity Disorder (NIH Publication No. 03-3572). Available online: http://www.nimh.nih.gov/publicat/adhd.cfm.

2. Shaw P, et al. (2007). Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences, 104(49): 19649-19654.

3. American Academy of Child and Adolescent Psychiatry (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46(7): 894-921.

4. Lamberg L (2003). ADHD often undiagnosed in adults: Appropriate treatment may benefit work, family, social life. JAMA, 290(12): 1565-1567.

5. American Psychiatric Association (2000). Attention-deficit and disruptive behavior disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 85-103. Washington, DC: American Psychiatric Association.

6. Jensen PS, et al. (2001). Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): Implications and applications for primary care providers. Developmental and Behavioral Pediatrics, 22(1): 60-73.

7. Schweitzer JB ,et al. (2001). Attention-deficit/hyperactivity disorder. Medical Clinics of North America, 85(3): 757-777.

8. Pharmacology and young children: How safe is methylphenidate in preschoolers? (2002). Brown University Psychopharmacology Update, 13(9): 2-3.

9. MTA Cooperative Group (2004). National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: Changes in effectiveness and growth after the end of treatment. Pediatrics, 113(4): 762-769.

10. Jensen PS, et al. (2007). 3-year follow-up of the NIMH MTA Study. Journal of the American Academy of Child and Adolescent Psychiatry, 46(8): 989-1002.

11. MTA Cooperative Group (1999). Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: The Multimodal Treatment Study of children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12): 1088-1096.

12. Jensen PS, et al. (2001). ADHD comorbidity findings from the MTA study: Comparing comorbid subgroups. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2): 147-158.

13. Wilens TE, et al. (2003). Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse: A meta-analytic review of the literature. Pediatrics, 111(1): 179-185.

14. Weiss M, Murray C (2003). Assessment and management of attention-deficit hyperactivity disorder in adults. Canadian Medical Association Journal, 168(6): 715-722.

15. U.S. Food and Drug Administration (2005). FDA issues public health advisory on Strattera (atomoxetine) for attention deficit disorder. FDA News P05-65. Available online: http://www.fda.gov/bbs/topics/NEWS/2005/NEW01237.html.

16. Brue AW, Oakland TD (2002). Alternative treatments for attention-deficit/hyperactivity disorder: Does evidence support their use? Alternative Therapies, 8(1): 68-74.

Other Works Consulted

• Dulcan MK, et al. (2003). Attention deficit/hyperactivity disorder section of Axis 1 disorders usually first diagnosed in infancy, childhood, or adolescence: Attention-deficit and disruptive behavior disorders. Concise Guide to Child and Adolescent Psychiatry, 3rd ed., pp. 24-41. Washington, DC: American Psychiatric Press.

• Hechtman L (2005). Attention-deficit/hyperactivity disorder section of Attention-deficit disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 2, pp. 3183-3198. Philadelphia: Lippincott Williams and Wilkins.

• McGough JJ (2005). Adult manifestations of attention-deficit/hyperactivity disorder section of Attention-deficit disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 2, pp. 3198-3204. Philadelphia: Lippincott Williams and Wilkins.

• Pritchard D (2006). Attention deficit hyperactivity disorder in children, search date May 2005. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

• Rappley MD (2005). Clinical practice: Attention deficit-hyperactivity disorder. New England Journal of Medicine, 352(2): 165-173.

• Sadock BJ, et al. ( 2007). Attention-deficit disorders. In Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences/Clinical Psychiatry, 10th ed., pp. 1206-1217. Philadelphia: Lippincott Williams and Wilkins.

• Stubbe D (2007). Attention deficit hyperactivity disorder. Child and Adolescent Psychiatry, pp. 57-68. Philadelphia: Lippincott Williams and Wilkins.

• Wilens TE, et al. (2004). Attention-deficit/hyperactivity disorder in adults. JAMA, 292(5): 619-623.

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