Attention-deficit/hyperactivity disorder (ADHD) is the condition used to describe children, adolescents and some adults who are inattentive, easily distracted, hyperactive and impulsive in their behavior. At least one child in a classroom of 20 is affected, and boys are more prone than girls. Some children are mainly inattentive (ADHD-inattentive subtype without hyperactivity), some are markedly hyperactive (ADHD hyperactive-impulsive subtype), and some have both types (ADHD combined type).
The cause is generally unknown, but it can be inherited and other immediate family members are often affected. Maternal smoking, premature birth, dietary additives and food sensitivities are can also cause ADHD.
Neurological examinations sometimes uncover minor but significant abnormalities or signs of ADHD, that may be helped by speech and occupational therapy. These subtle neurological abnormalities (or “soft signs”) include:
An electroencephalogram (EEG) may be performed as part of the neurological examination. A sleep-deprived EEG is recommended in children who also have episodes of altered awareness, staring and daydreaming, or a family history of epilepsy.
We use several approaches to treating children with ADHD. The appropriate treatment will change depending on the age of the child. For preschoolers, behavior modification is the best treatment. For school-age children and adolescents, medication is usually recommended.
ADD/ADHD is a chronic disorder and requires long-term therapy, usually beginning with stimulant medication (such as methylphenidate). Stimulants are avoided or used in smaller doses in children with a history of epilepsy or an abnormal EEG, and a non-stimulant (atomoxetine or guanfacine) may be used instead. Stimulants may not be prescribed for children with a tic disorder (Tourette syndrome) or cardiac abnormality.
Dietary modification is an alternative therapy to medication and is sometimes favored by parents. Parents are provided with a list of preferred foods and foods to avoid in children with ADD/ADHD.
Learning disabilities (such as reading impairment) and oppositional behavior (ODD) are common complications of ADD/ADHD and may require psychological evaluation, counseling and educational intervention. An IEP, or individual educational program, may need to be created for your child.
Frequent medical follow-ups with attention to growth, cardiovascular function and drug monitoring, and reference to teacher reports and academic performance is important. Patients with ADHD but who also have depressive anxiety, obsessive-compulsive disorder or autistic spectrum disorder are referred to psychiatry for consultation and management.