Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. Problems associated with ADHD include inattention and hyperactive, impulsive behaviour. Children with ADHD may struggle with low self-esteem, troubled relationships and poor performance in school.
While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves psychological counselling, medications or both.
A diagnosis of ADHD can be scary, and symptoms can be a challenge for parents and children alike. However, treatment can make a big difference, and the majority of children with ADHD grow up to be vibrant, active and successful adults.
ADHD has been called attention-deficit disorder (ADD) and hyperactivity. But ADHD is the preferred term because it describes both primary aspects of the condition: inattention and hyperactive-impulsive behaviour.
While many children who have ADHD tend more toward one category than the other, most children have some combination of inattention and hyperactive-impulsive behaviour. Signs and symptoms of ADHD become more apparent during activities that require focused mental effort.
In most children diagnosed with ADHD, signs and symptoms appear before the age of 7. In some children, signs of ADHD are noticeable as early as infancy.
Signs and symptoms of inattention may include:
Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
Often has trouble sustaining attention during tasks or play
Seems not to listen even when spoken to directly
Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks
Often has problems organizing tasks or activities
Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
Frequently loses needed items, such as books, pencils, toys or tools
Can be easily distracted
Signs and symptoms of hyperactive and impulsive behaviour may include:
Fidgets or squirms frequently
Often leaves his or her seat in the classroom or in other situations when remaining seated is expected
Often runs or climbs excessively when it's not appropriate or, if an adolescent, might constantly feel restless
Frequently has difficulty playing quietly
Always seems on the go
Blurts out the answers before questions have been completely asked
Frequently has difficulty waiting for his or her turn
Often interrupts or intrudes on others' conversations or games
ADHD behaviours can be different in boys and girls.
Boys are more likely to be hyperactive, whereas girls tend to be inattentive.
Girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly.
Boys tend to be less compliant with teachers and other adults, so their behaviour is often more conspicuous.
Normal behaviour vs. ADHD Most healthy children are inattentive, hyperactive or impulsive at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end may have ADHD. But preschoolers normally have a short attention span and aren't able to stick with one activity for long. Even in older children and adolescents, attention span often depends on the level of interest. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than do others. Children should never be classified as having ADHD just because they're different from their friends or siblings.
Children who have problems in school but get along well at home or with friends are not considered to have ADHD. The same is true of children who are hyperactive or inattentive only at home but whose schoolwork and friendships aren't affected by their behaviour.
When to see a doctor If your child has disruptive behaviours you think may be signs of ADHD, such as trouble concentrating, sitting still or controlling his or her behaviour, see your paediatrician or family doctor. Your doctor may refer you to a specialist, but it's important to have a medical evaluation first to check for likely causes of your child's signs and symptoms.
If your child is already being treated for ADHD, he or she should see the doctor regularly — at least once during the month following diagnosis, and then at least every six months after that. Be sure to discuss how often your child should be seen for appointments with his or her doctor. Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping or increased irritability. Over time some children taking stimulant medications may also lose weight or grow more slowly, although these changes are usually temporary.
Researchers increasingly believe that causes have more to do with inherited traits than parenting choices. At the same time, certain environmental factors may contribute to or worsen a child's behaviour. Although there's still a lot that isn't known about ADHD, researchers have identified several factors that may play a role:
Altered brain function and anatomy. While the exact cause of ADHD remains a mystery, brain scans have revealed important differences in the structure and brain activity of people with ADHD. For example, there appears to be less activity in the areas of the brain that control activity and attention.
Heredity. ADHD tends to run in families. About one in four children with ADHD have at least one relative with the disorder.
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 neurotransmitters. Pregnant women who are exposed to environmental poisons, such as polychlorinated biphenyls (PCBs), also may be more likely to have children with symptoms of ADHD. PCBs are industrial chemicals that were widely used up until the 1970s.
Childhood exposure to environmental toxins. Preschool children exposed to certain toxins are at increased risk of developmental and behavioural problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behaviour and to a short attention span. Exposure to PCBs in infancy also may increase a child's risk of developing ADHD.
Maternal exposure to toxins
Smoking, drinking alcohol or using drugs during pregnancy
A family history of ADHD or certain other behavioural and mood disorders
ADHD frequently occurs along with certain other conditions, including:
Having a learning disability or being a gifted learner
Oppositional defiant disorder
Food additives do they cause hyperactivity?
from John E. Huxsahl, M.D.
There's no evidence that food additives cause attention-deficit/hyperactivity disorder (ADHD), but an increasing number of studies show that certain food colourings and preservatives may cause or worsen hyperactive behaviour in some children. Because several studies looked at a combination of food additives and their possible effects on hyperactivity and ADHD, it isn't clear which additives may affect behaviour.
Food additives that may increase hyperactive behaviour include:
FD&C Yellow No. 6 (sunset yellow)
D&C Yellow No. 10 (quinoline yellow)
FD&C Yellow No. 5 (tartrazine)
FD&C Red No.40 (allura red)
FD&C Yellow No. 5, used in beverages, candy, ice cream, custards and other foods, may be more likely to cause reactions than other additives. The Food and Drug Administration requires that FD&C Yellow No. 5 be clearly labelled on food packaging along with other ingredients. But many colourings and food additives don't require similar labelling, so it can be difficult to tell whether a food contains artificial colouring or other additives. One rule of thumb is that brightly collared processed foods are most likely to contain one or more colouring additives.
More research is needed regarding whether limiting certain foods helps prevent hyperactivity and ADHD symptoms. If you notice that a certain food causes a change in your child's behaviour, you may want to try eliminating it from your child's diet to see if it makes a difference. However, consult with your child's doctor before putting your child on a limited diet. A diet that eliminates too many foods can be unhealthy because it may lack necessary vitamins and nutrients.
The approach for your child's overall health and nutrition is a diet that limits sugary and processed foods and is rich in fruits, vegetables, grains and healthy fats such as omega-3 fatty acids found in fish, flaxseed and other foods.