About attention deficit hyperactivity disorder

What is attention deficit hyperactivity disorder?

Attention deficit hyperactivity disorder (ADHD) is a mental-health condition that has characteristics of difficulty concentrating, controlling impulses, and/or excessive activity.

  • Though there is no particular cause of ADHD, there are many social, biological, environmental factors that may raise one's risk of developing or being diagnosed with the disorder.
  • There are three kinds of ADHD: predominately inattentive, predominately hyperactive/impulsive, and the combined (inattentive, hyperactive, and impulsive).
  • While medications are commonly used in the treatment of ADHD, behavioral therapy is important in improving the child's ability to function as well.
  • The most common medications used to treat ADHD are the stimulant medications.
  • About 85% of children with ADHD are at risk for having the disorder in adulthood.
  • Much of the latest research on ADHD in children focuses on how exposure to environmental toxins may increase the risk of developing this condition.

What is attention deficit hyperactivity disorder (ADHD)?

ADHD, also often called ADD, refers to a mental-health condition called attention-deficit/hyperactivity disorder. People with ADHD have problems with impulse control, excessive activity, and/or concentration. Statistics show that up to 7% of children and teens are thought to suffer from this disorder at any time, with up to 11% of children being given the diagnosis at some point during their childhood. Physicians diagnose boys with childhood ADHD at a rate of more than twice that of girls. That is thought to be at least partly due to the diagnosis in girls being missed because of gender differences in ADHD symptoms.

What are the symptoms for attention deficit hyperactivity disorder?

Symptoms in children

Symptoms are grouped into three types:

Inattentive. A child with ADHD:

  • Is easily distracted
  • Doesn't follow directions or finish tasks
  • Doesn't seem to be listening
  • Doesn't pay attention and makes careless mistakes
  • Forgets about daily activities
  • Has problems organizing daily tasks
  • Doesn’t like to do things that require sitting still
  • Often loses things
  • Tends to daydream

What are the causes for attention deficit hyperactivity disorder?

Experts aren’t sure what causes ADHD. Several things may lead to it, including:

  • Genes. ADHD tends to run in families.
  • Chemicals. Brain chemicals in people with ADHD may be out of balance.
  • Brain changes. Areas of the brain that control attention are less active in children with ADHD.
  • Poor nutrition, infections, smoking, drinking, and substance abuse during pregnancy. These things can affect a baby’s brain development.
  • Toxins, such as lead. They may affect a child's brain development.
  • A brain injury or a brain disorder. Damage to the front of the brain, called the frontal lobe, can cause problems controlling impulses and emotions.

Sugar doesn’t cause ADHD. ADHD also isn’t caused by too much TV, a stressful home life, poor schools, or food allergies.

What are the treatments for attention deficit hyperactivity disorder?

While medications are often prominent in the treatment of ADHD, behavioral treatments that address the interactions that the child with ADHD has with his or her parents, peers, and in school are also important in improving the child's ability to function. Mental-health professionals therefore often work with parents to develop specialized parenting skills and with teachers to provide academic accommodations, thereby encouraging and reinforcing the child's strengths, decreasing the child's counterproductive behaviors, and maximizing the child's academic success. They also may enlist the child in a social-skills group of their peers to improve the ADHD child's ability to make and keep friends.

Children with ADHD often benefit from being prescribed medication. The most common medications used to treat this disorder are the stimulant medications. Perhaps the oldest prescribed stimulant for the treatment of ADHD is Ritalin. However, given the longer days that older children and teens have compared to young children, stimulants that last longer are usually prescribed for those age groups. Examples of these prescribed drugs include long-acting preparations of methylphenidate, like Daytrana patches, Quillivant-XR liquid, Ritalin-LA, Concerta, and dexmethylphenidate (Focalin-XR), as well as the long-acting amphetamine salt Adderall-XR. Long-acting stimulants also include lisdexamfetamine (Vyvanse). However, shorter-acting stimulants like amphetamine salt (Adderall), dextroamphetamine sulfate (Zenzedi), and methylphenidate preparations, like Focalin and Metadate, may be more suitable for younger children so they are less likely to have trouble sleeping at night. Daytrana and a liquid form of methylphenidate called Quillivant XR can be useful in younger children because these two medications do not present trouble swallowing for children. Vyvanse can also be useful in that regard since its capsules can be opened and put in liquid or on food. Also, the effect of the Daytrana patch comes out of the child's system soon after the patch is removed, allowing parents to have more control over how long they would like the medication effect to last each day.

Some children and adolescents may need to take a nonstimulant medication for treatment of ADHD. For those whose symptoms early in the morning or late in the evening are an issue, stimulants may not be the optimal medication treatment. For others, side effects like low appetite, insomnia, tremors, depression, loss of exuberance, irritability, less frequently tics, and rarely hallucinations may make it unwise for the child to take a stimulant medication. While stimulant treatment of people with ADHD who have no history of drug abuse tends to contribute to a decreased likelihood of developing a substance-abuse problem later on, those who have a recent history of alcohol or other drug abuse may make the small but real addiction potential of stimulants a reason not to prescribe a medication from that group. For children who either experience suboptimal effects, side effects, or significant side effects of stimulants, nonstimulant medications like guanfacine (Tenex or Intuniv), clonidine (Catapres or Kapvay), or atomoxetine (Strattera) may be considered. The prescription dietary supplement Vayarin has also been found to be effective in treating childhood ADHD.

Children who suffer from ADHD are at higher risk for developing mood problems during adulthood. They may therefore benefit from medications that have been found to be helpful for people who have both ADHD and depression or anxiety, like bupropion (Wellbutrin) or venlafaxine (Effexor).

While further research is needed to determine the potential effectiveness of home or natural remedies for treatment of ADHD, a number of parents use such treatments without drugs in an attempt to help their children. Such alternative treatments include vitamin supplements and restrictions to the child’s diet. A significant limitation of these remedies includes the difficulty in implementing them. The Feingold diet (developed in the 1970s) involves omitting food additives in an attempt to alleviate ADHD symptoms. While the Feingold diet may help some individual children, it has long ago been deemed ineffective for most.

Lifestyle improvements have been found to help reduce some symptoms in some children. Such improvements include regular exercise and ensuring the person receives adequate sleep every night. In fact, there is research that indicates that regular physical activity can measurably decrease ADHD symptoms, particularly in young children. Children who have trouble sleeping may benefit from over-the-counter medications that are not habit forming, such as melatonin.

What are the risk factors for attention deficit hyperactivity disorder?

  • Genes. ADHD tends to run in families.
  • Chemicals. Brain chemicals in people with ADHD may be out of balance.
  • Brain changes. Areas of the brain that control attention are less active in children with ADHD.
  • Poor nutrition, infections, smoking, drinking, and substance abuse during pregnancy. These things can affect a baby’s brain development.
  • Toxins, such as lead. They may affect a child's brain development.
  • A brain injury or a brain disorder. Damage to the front of the brain, called the frontal lobe, can cause problems controlling impulses and emotions.

Sugar doesn’t cause ADHD. ADHD also isn’t caused by too much TV, a stressful home life, poor schools, or food allergies.

Is there a cure/medications for attention deficit hyperactivity disorder?

Stimulants

Stimulants are the most commonly prescribed medications for ADHD. They’re often the first course of drugs used for ADHD treatment.

You might hear this class of drugs called central nervous system (CNS) stimulant medications. They work by increasing the amounts of the hormones called dopamine and norepinephrine in the brain.

This effect improves concentration and decreases the fatigue that’s common with ADHD.

Many brand-name stimulants are now only available as generic versions, which cost less and may be preferred by some insurance companies. However, other drugs are only available as brand-name products.

Amphetamines

Amphetamines are stimulants used for ADHD. They include:

  • amphetamine
  • dextroamphetamine
  • lisdexamfetamine

They come in immediate-release (a drug that’s released into your body right away) and extended-release (a drug that’s released into your body slowly) oral forms. Brand names of these drugs include:

  • Adderall XR (generic available)
  • Dexedrine (generic available)
  • Dyanavel XR
  • Evekeo
  • ProCentra (generic available)
  • Vyvanse

Methamphetamine (Desoxyn)

Methamphetamine is related to ephedrine and amphetamine. It also works by stimulating the CNS.

It’s not known exactly how this drug works to help ADHD symptoms. Like other stimulants, methamphetamine may increase the amounts of hormones like dopamine and norepinephrine in your brain.

It can reduce your appetite and increase your blood pressure. This drug comes as an oral tablet taken once or twice per day.

Methylphenidate

Methylphenidate works by blocking the reuptake of norepinephrine and dopamine in your brain. This helps increase levels of these hormones.

It’s also a stimulant. It comes in immediate-release, extended-release, and controlled-release oral forms.

It also comes as a transdermal patch under the brand name Daytrana. Brand names include:

  • Aptensio XR (generic available)
  • Metadate ER (generic available)
  • Concerta (generic available)
  • Daytrana
  • Ritalin (generic available)
  • Ritalin LA (generic available)
  • Methylin (generic available)
  • QuilliChew
  • Quillivant

Dexmethylphenidate is another stimulant for ADHD that’s similar to methylphenidate. It’s available as the brand-name medication Focalin.

Nonstimulants

Nonstimulants affect the brain differently than stimulants do. These drugs also affect neurotransmitters, but they don’t increase dopamine levels. In general, it takes longer to see results from these drugs than from stimulants.

These drugs come in several classes. A doctor might prescribe them when stimulants aren’t safe or are ineffective. They may also prescribe them if a person wants to avoid the side effects of stimulants.

Atomoxetine (Strattera)

Atomoxetine (Strattera) blocks the reuptake of norepinephrine in the brain. This lets norepinephrine work longer.

The drug comes as an oral form you take once or twice per day. This drug is also available as a generic.

Atomoxetine has caused liver damage in a small number of people. If you have signs of liver problems while taking this drug, your doctor will check your liver function.

Signs of liver problems include:

  • a tender or swollen abdomen
  • yellowing of your skin or the whites of your eyes
  • fatigue

Clonidine ER (Kapvay)

Clonidine ER (Kapvay) is used to reduce hyperactivity, impulsiveness, and distractibility in people with ADHD. Other forms of clonidine are used to treat high blood pressure.

Because it also lowers blood pressure, people taking it for ADHD may feel lightheaded.

This drug is available as a generic.

Guanfacine ER (Intuniv)

Guanfacine is normally prescribed for high blood pressure in adults. This drug is available as a generic, but only the time-release version and its generics are approved for use in children with ADHD.

The time-release version is called Guanfacine ER (Intuniv).

This drug may help with memory and behavioral problems. It may also help improve aggression and hyperactivity.

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