Overview
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and can continue into adulthood. It is characterized by short attention span, hyperactivity, and impulsivity.
It is seen in approximately 7% of children and 2-5% of adults. It is 2-3 times more common in boys than girls. With early diagnosis and proper treatment, children can succeed in school and social life.
Symptoms
ADHD shows three main symptom groups:
Attention deficit:
- Not paying attention to details, careless mistakes
- Difficulty focusing on tasks
- Appears not to listen
- Inability to follow instructions, leaving tasks unfinished
- Organizational problems, losing items
- Avoiding tasks requiring mental effort
- Easily distracted
- Forgetfulness
Hyperactivity:
- Inability to sit still, fidgeting
- Not being able to sit in class or in one place
- Running, climbing in inappropriate situations
- Not being able to play quietly
- Excessive talking
- Constantly on the move
Impulsivity:
- Answering before questions are completed
- Not waiting one's turn
- Interrupting others
- Acting without thinking
In adults, hyperactivity often becomes inner restlessness; attention problems and difficulty with organization come to the forefront.
Causes
The exact cause is unknown; multifactorial:
- Genetics: Family history is the strongest risk factor
- Brain structure and chemistry: Imbalance of dopamine and norepinephrine
- Pregnancy factors: Smoking, alcohol, drugs, preterm birth
- Environmental factors: Lead exposure, head trauma
Sugar, food coloring, excessive TV watching, or poor parenting do NOT cause ADHD; however, they may worsen symptoms.
Risk Factors
- Family history
- Smoking, alcohol, drug use during pregnancy
- Preterm birth, low birth weight
- Being male
- Exposure to environmental toxins
Complications
- School failure, repeating a grade
- Low self-esteem
- Peer relationship problems
- Family conflict
- Accidents and injuries (especially due to impulsivity)
- Risk of substance abuse
- Anxiety, depression
- Problems in work life (in adults)
- Traffic accidents
- Early sexual activity, risky behaviors
When to See a Doctor
- Symptoms lasting more than 6 months
- Occurring in more than one setting (home, school)
- Affecting academic or social life
- Symptoms beginning before age 7
- Teacher or pediatrician referral
Diagnosis and Treatment
Diagnosis:
- Evaluation by a child-adolescent psychiatrist
- Detailed interview (child, family, teacher)
- Standardized rating scales (Conners, SNAP)
- IQ and neuropsychological tests
- Screening for co-occurring conditions
Treatment (multimodal approach):
1. Medication:
- Stimulants: Methylphenidate, lisdexamfetamine — most effective (70-80%)
- Non-stimulant medications: Atomoxetine, guanfacine
- Recommended in children over 6
- Side effects: loss of appetite, sleep difficulty, headache
2. Behavioral therapy:
- Cognitive behavioral therapy
- Social skills training
- Parent training programs
- School support (educational plans, classroom accommodations)
3. Educational and organizational strategies:
- Task lists, calendars
- Visual reminders
- Short breaks
- Quiet work environment
4. Lifestyle adjustments:
- Regular sleep
- Exercise (very effective)
- Balanced nutrition
- Screen time limits
- Stress management
Prevention and Recommendations for Families
- Avoid smoking, alcohol, and drugs during pregnancy
- Protect children from environmental toxins (lead)
- Establish a regular and consistent daily routine
- Give short, clear instructions
- Reward positive behaviors
- Provide constructive feedback rather than punishment
- Use visual cues and lists
- Encourage exercise
- Ensure adequate sleep
- Limit screen time
- Stay in contact with the teacher
- Seek professional support
- Focus on the child's strengths