Ever wonder what is ADHD? What causes it? How is it diagnosed? I'm not a doctor but a parent of two beautiful girls who happen to be ADHD. This is what I've learned in the last 10 years of being a parent with ADHD. 

What Are the Symptoms?
ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD It is broken down into three types, each with its own types of behaviours:

1. Inattentive type, with signs that include:
• inability to pay attention to details or makes careless errors in schoolwork and/or other activities 
• difficulty with staying attentive in tasks or play activities 
• apparent listening problems (get their hearing tested!)
• difficulty following instructions 
• problems with organization 
• avoidance or dislike of tasks that require mental effort 
• tendency to lose things like toys, notebooks, or homework 
• distractibility 
• forgetfulness in daily activities 

2. Hyperactive-impulsive type, with signs that include:
• fidgeting or squirming 
• difficulty remaining seated 
• excessive running or climbing 
• difficulty playing quietly 
• always seeming to be "on the go" 
• excessive talking 
• blurting out answers before hearing the full question 
• difficulty waiting for a turn or in line 
• problems with interrupting or intruding 
• social activity problems - hard making/keeping friends

3. Combined type, which involves a combination of the other two types (is the most common)
Although it can often be challenging to raise kids with ADHD, it's important to remember they aren't "bad," "acting out," or being difficult on purpose. And children who are diagnosed with ADHD have difficulty controlling their behavior without medication or behavioral therapy. 

When the diagnosis is in doubt, or if there are other concerns, such as Tourette syndrome, a learning disability, or depression, a child may be referred to a neurologist, psychologist, or psychiatrist. Ultimately, though, the primary care doctor gathers the information, makes the diagnosis, and starts treatment. So pick a good doctor that is not going to rush into things.

To be considered for a diagnosis of ADHD:
• a child must display behaviors from one of the three types before age 7 
• these behaviours must be more severe than in other kids the same age 
• the behaviors must last for at least 6 months 
• the behaviours must occur in and negatively affect at least two areas of a child's life (such as school, home, day-care settings, or friendships) 
• The behaviours must also not be linked to stress at home. Children who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid a misdiagnosis, it's important to consider whether these factors played a role in the onset of symptoms.

First, your child's doctor will perform a physical exam on your child and ask you about any concerns and symptoms, your child's past health, your family's health, any medications your child is taking, any allergies your child may have, and other issues. Be prepared, this will take about an hour or two with the doctor!  This is called the medical history, and it's important because research has shown that ADHD has a strong genetic link and often runs in families. It does in my family!

Your child's doctor may also request other tests to check hearing and vision so other medical conditions can be ruled out. Because some emotional conditions, such as extreme stress, depression, and anxiety, can also look like ADHD, you'll probably be asked to fill out questionnaires that can help rule them out as well.

You'll also likely be asked many questions about your child's development and his or her behaviors at home, at school, and among friends. Other adults who see your child regularly, like teachers, who are often the first to notice ADHD symptoms will probably be consulted, too. The doctor uses forms with question on it - in my area - its called a SNAP test. I fill it out too, this helps the doctor alot, when she/he is determining if the medication or therapy is working. An educational evaluation, which usually includes a school psychologist, may also be done. It's important for everyone involved to be as honest and thorough as possible about your child's strengths and weaknesses. The more support in the education system and the community the better chance for your child to lead a normal life.

ADHD has biological origins that aren't yet clearly understood. No single cause of ADHD has been identified, but researchers have been exploring a number of possible genetic and environmental links. Studies have shown that many children with ADHD have a close relative who also has the disorder. My girls have many cousins with it.

Although experts are unsure whether this is a cause of the disorder, they have found that certain areas of the brain are about 5% to 10% smaller in size and activity in children with ADHD. Chemical changes in the brain have been found as well. How my doctor explained it - the electrical waves in the brain is moving so fast - the brain can't register it properly. Thus miss firing.

Recent research also links smoking during pregnancy to later ADHD in a child. Other risk factors may include premature delivery, very low birth weight, and injuries to the brain at birth. Some studies have even suggested a link between excessive early television watching and future attention problems. 

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)
At least 35% of all children with ADHD also have oppositional defiant disorder, which is characterized by stubbornness, outbursts of temper, and acts of defiance and rule breaking. Conduct disorder is similar but features more severe hostility and aggression. Children who have conduct disorder are more likely get in trouble with authority figures and, later, possibly with the law. Oppositional defiant disorder and conduct disorder are seen most commonly with the hyperactive and combined subtypes of ADHD.

Mood Disorders (such as depression)
About 18% of children with ADHD, particularly the inattentive subtype, also experience depression. They may feel inadequate, isolated, frustrated by school failures and social problems, and have low self-esteem.

Anxiety Disorders
Anxiety disorders affect about 25% of children with ADHD. Symptoms include excessive worry, fear, or panic, which can also lead to physical symptoms such as a racing heart, sweating, stomach pains, and diarrhea. Other forms of anxiety that can accompany ADHD are obsessive compulsive disorder and Tourette syndrome, as well as motor or vocal tics (movements or sounds that are repeated over and over). A child who has symptoms of these other conditions should be evaluated by a specialist.

Learning Disabilities
About half of all children with ADHD also have a specific learning disability. The most common learning problems are with reading (dyslexia) and handwriting. Although ADHD isn't categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform well in school.

If your child has ADHD and a coexisting condition, the doctor will carefully consider that when developing a treatment plan. Some treatments are better than others at addressing specific combinations of symptoms.

In most cases, ADHD is best treated with a combination of medication and behavior therapy. Any good treatment plan will require close follow-up and monitoring, and your child's doctor may make adjustments along the way. So this includes possible trips every other month to possibly once a month when there is changes in the medication. Because it's important for parents to actively participate in their child's treatment plan, parent education is also considered an important part of ADHD management.

Medications
Several different types of medications may be used to treat ADHD:

Stimulants are the best known treatments - they've been used for more than 50 years in the treatment of ADHD. Some require several doses per day, each lasting about 4 hours; some last up to 12 hours. 
Possible side effects include: 
• decreased appetite, 
• stomachache, 
• irritability, and 
• insomnia. 
There's currently no evidence of any long-term side effects. 

Non stimulants were approved for treating ADHD in 2003. These appear to have fewer side effects than stimulants and can last up to 24 hours. 
Antidepressants are sometimes a treatment option; however, in 2004 the FDA issued a warning that these drugs may lead to a rare increased risk of suicide in children and teens. 

Behavioral Therapy
Research has shown that medications used to help curb impulsive behavior and attention difficulties are more effective when they're combined with behavioral therapy. Thus medication is not a cure but an aid.

Behavioral therapy attempts to change behavior patterns by:
• reorganizing your child's home and school environment 
• giving clear directions and commands (they find it confusing if given too many!)
• setting up a system of consistent rewards for appropriate behaviors and negative consequences for inappropriate ones 

Parents should always be wary of any therapy that promises an ADHD "cure," and if they're interested in trying something new, they should be sure to speak with their child's doctor first. ADHD is controlled, not cured.

In addition to using routines and a clear system of rewards, here are some other tips to share with teachers for classroom success:
• Reduce seating distractions. Lessening distractions might be as simple as seating your child near the teacher instead of near the window. 
• Use a homework folder for parent teacher communications. The teacher can include assignments and progress notes, and you can check to make sure all work is completed on time. 
• Break down assignments. Keep instructions clear and brief, breaking down larger tasks into smaller, more manageable pieces. 
• Give positive reinforcement. Always be on the lookout for positive behaviors. Ask the teacher to offer praise when your child stays seated, doesn't call out, or waits his or her turn, instead of criticizing when he or she doesn't. 
• Teach good study skills. Underlining, note taking, and reading out loud can help your child stay focused and retain information. 
• Supervise. Check that your child goes and comes from school with the correct books and materials. Ask that your child be paired with a buddy who can help him or her stay on task. 
Be sensitive to self-esteem issues. Ask the teacher to provide feedback to your child in private, and avoid asking your child to perform a task in public that might be too difficult. 
Involve the school counselor or psychologist. He or she can help design behavioral programs to address specific problems in the classroom. 

Reference / Source

• Hartmann,Thom "Attention Deficit Disorder, A Different Perception" subtitled "A Hunter in a Farmers World". 
• Barkley, Russell A. Take Charge of ADHD: The Complete Authoritative Guide for Parents (2005) New York: Guilford Publications.
• Conrad, Peter Identifying Hyperactive Children (Ashgate, 2006). 
• Green, Christopher, Kit Chee, Understanding ADD; Doubleday 1994
• www.ADHD.ca
• www.WebMd.com
• www.SchwabLearning.org
 
 

This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.