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attention deficit disorder

Alternative Names
ADD, ADHD, attention deficit hyperactivity disorder

Attention deficit disorder (ADHD) involves a persistent pattern of inattention or impulsivity. Attention deficit hyperactivity disorder adds a level of hyperactivity to the other symptoms of ADD. The behaviour is more frequent and severe than in other children the same age.

What are the signs and symptoms of the condition?
Someone who has ADD/ADHD:
  • often fails to give close attention to details
  • makes careless mistakes in schoolwork or other activities
  • often has difficulty staying focused on tasks
  • may not seem to listen when spoken to directly
  • frequently does not follow instructions
  • fails to finish schoolwork, chores, or duties at work
  • has difficulty organising tasks and activities
  • avoids or dislikes tasks that require mental effort, such as schoolwork or homework
  • frequently loses things like schoolbooks and assignments
  • is easily distracted by things happening around him or her
  • forgets to do important daily activities
  • often fidgets with hands or feet
  • has trouble sitting still for very long
  • frequently runs around or climbs on things
  • has difficulty playing or working quietly
  • acts as if driven by a motor
  • talks too much
  • frequently blurts out answers before a question is finished
  • has difficulty waiting to take a turn
  • often interrupts people, or butts into conversations or games
What are the causes and risks of the condition?
The exact causes of ADD/ADHD are unknown. Some children have factors that have been shown to increase the risk, including: What can be done to prevent the condition?
Very little can be done to prevent ADD/ADHD. It is important to recognise the signs of the disease as early as possible and to get treatment quickly.

How is the condition diagnosed?
A psychologist or psychiatrist is usually consulted about ADD/ADHD. But many social workers, psychiatric nurses, and paediatricians are also trained to provide a good diagnostic evaluation. In adults, the diagnosis is based on the reports of the affected person and people who know the person. It is important to have family members or co-workers involved in the evaluation. For children, both the parents and the teachers need to fill out questionnaires about symptoms that they have seen.

Diagnosis is based on many of these symptoms. The symptoms need to cause a problem and occur in more than one situation (for example, at home and at school). Symptoms also need to be present before the age of 7. Symptoms that start much later than this might be a sign of some other problem. Many children may have a few of the symptoms from time to time. There is only reason for concern if the symptoms occur much more often than in most children.

What are the long-term effects of the condition?
Untreated ADD/ADHD can lead to a number of problems. Affected children and adults have difficulty doing well at school and at work. If they are not treated, children often begin to hate school. They are more likely to quit school early and turn to alcohol and drugs as they grow older. Even those who stay in school can suffer from feelings of inferiority. They are often seen as "bad" kids because of their behaviour. Many children with ADD/ADHD grow up believing that they really are bad.

About 30% to 50% of children with ADD/ADHD will continue to be affected as adults. The disorder can have many long-term effects. Among these are completing fewer years of school, difficulty keeping a job, more car accidents, more alcohol and drug abuse, more court appearances and felony convictions, and more suicide attempts. They may find relationships difficult and are more likely to have failed marriages.

What are the risks to others?
There are no direct risks to others.

What are the treatments for the condition?
Both medication and psychotherapy are used to treat ADD/ADHD. Family support, education, and appropriate school placements are always helpful. But they have not been found to be as effective as medications. Most children with ADD/ADHD are treated successfully with stimulants, such as Ritalin or Dexamphetamine. A few other drugs can also help reduce the symptoms, including bupropion, tricyclic antidepressants, and clonidine.

What are the side effects of the treatments?
Common side effects of stimulants include trouble falling asleep, reduced appetite, weight loss, stomach aches, headaches, and jitteriness. Some children become unusually hyperactive when the medication wears off. Stimulants may cause some children to grow more slowly. In the long term, they will grow to their normal height. Most of the side effects get better over time. Changing the amount of medication or the time the medication is given can also improve side effects.

What happens after treatment for the condition?
Most children take medication only during the school year, and have a "drug holiday" during the summer. Many doctors will not restart the medication as soon as school starts in order to see whether the child still needs it. As children grow older, many are able to do well with no medication or a reduced dose. Between 50% and 70% of children with ADD/ADHD eventually outgrow the disorder.

How is the condition monitored?
Anyone who takes medication needs to be monitored by a doctor. Height and weight are watched to make sure that the child is growing normally. Periodically, teachers and parents fill out behaviour questionnaires to be sure the symptoms are well controlled by the medication. It is important to monitor school performance. Worsening school performance can be a sign that the disorder is not in control. Children with ADD/ADHD are also at risk for depression and anxiety problems. Parents need to watch for these symptoms and report them to the doctor immediately.

Author: Michael Johnson, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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