Let’s Talk About Attention Deficit Hyperactivity Disorder

SAMHSA Blog By: Elinore F. McCance-Katz, M.D., Ph.D., FAAAP, Chief Medical Officer, Substance Abuse and Mental Health Services Administration and Paolo del Vecchio, M.S.W., Director, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration

Attention Deficit Hyperactivity Disorder (ADHD) usually begins in children aged 12 years and younger, and can continue through adolescence and into adulthood.  The National Institute of Mental Health (NIMH) reports that approximately 9 percent of children and youth age 13 to 18 years have ADHD and about 4.1 percent of American adults age 18 years and older are diagnosed with ADHD in any given year.

ADHD symptoms include inattention, problems staying on task, difficulty completing assignments, problems with organization, being forgetful, and sometimes losing things.  Hyperactivity and impulsivity are often components of ADHD and may appear as restlessness, running about or climbing where inappropriate, being difficult to ‘keep up with,’ talking excessively, blurting out answers, having difficulty waiting for a turn, and interrupting others.  To be diagnosed with ADHD, children who exhibit these symptoms must do so in at least two settings (for example home and school), and the symptoms must interfere with, or reduce quality of life, and school or occupational performance for at least six months.

Parents of children with ADHD may first notice that their child loses interest in things sooner than other children, or seems “unfocused” or “out of control.”  Teachers may notice symptoms when a child has trouble following rules or frequently seems not to be paying attention in the classroom or on the playground.  It is important to exclude other medical problems such as depression, anxiety, learning disabilities, and hearing deficits which can be associated with behaviors that may appear to be those of ADHD.  Since stressors or trauma can be associated with symptoms described as ADHD in children, medical records and collateral information about behaviors and situations at school, home, and during other activities need to be reviewed first to determine whether the symptoms impair the child’s quality of life or stem from other things.

Treatment of ADHD usually entails a combination of medication, therapy, and recovery supports.  FDA-approved medication treatments are available to treat individuals with ADHD, including stimulants and non-stimulant medications that reduce hyperactivity and impulsivity and improve ability to focus, work and learn.

Behavioral therapies help a child change behaviors such as organizing tasks, approaches to completing schoolwork, and coping with stressful or challenging situations.  Therapies that employ structure such as daily routines to be followed, or feedback on behavior from parents and/or teachers can also be helpful.  Over time, children with ADHD can be taught to monitor their behavior and to avoid the hyperactivity, impulsivity and inattention that can accompany ADHD.

Many children, though not all diagnosed in childhood, will continue to experience symptoms of the disorder in adulthood requiring ongoing treatment and supports.  Medication treatments effective in childhood can be effective for adults as well, although adults may develop other disorders that require treatments that can have negative interactions with ADHD medications, particularly stimulants, or they may develop other physical conditions that can be worsened by stimulant use such as heart disease.  Therefore, it is important that individuals with ADHD continue to receive both mental health care and care for their physical health to assure safe and effective treatment of ADHD and any other co-occurring conditions.

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