What is ADHD?
ADHD (attention deficit hyperactivity disorder) is an ongoing behavior disorder typically diagnosed at age five or six, although the symptoms have usually been observed much earlier than this age. The three key symptoms are:- Inattention
- Hyperactivity
- Impulsivity
Inattention Symptoms in ADHD
The child often fails to give attention to details, or makes careless mistakes in schoolwork, work, or other activities.Inattention Symptoms in ADHD
The child often has difficulty sustaining attention in tasks or play activities.Inattention Symptoms in ADHD
The child often does not seem to listen when spoken to directly.Inattention Symptoms in ADHD
The child often does not follow through on instructions and fails to finish schoolwork, chores, (not due to oppositional behavior or failure to understand instructions).An additional symptom of ADHD in adults is the lack of follow through on instructions or failure to finish duties in the workplace.
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What is ADHD?
ADHD (attention deficit hyperactivity disorder) is an ongoing behavior disorder typically diagnosed at age five or six, although the symptoms have usually been observed much earlier than this age. The three key symptoms are:- Inattention
- Hyperactivity
- Impulsivity
Inattention Symptoms in ADHD
The child often fails to give attention to details, or makes careless mistakes in schoolwork, work, or other activities.Inattention Symptoms in ADHD
The child often has difficulty sustaining attention in tasks or play activities.Inattention Symptoms in ADHD
The child often does not seem to listen when spoken to directly.Inattention Symptoms in ADHD
The child often does not follow through on instructions and fails to finish schoolwork, chores, (not due to oppositional behavior or failure to understand instructions).An additional symptom of ADHD in adults is the lack of follow through on instructions or failure to finish duties in the workplace.
Inattention Symptoms in ADHD
The child often has difficulty organizing tasks and activities.Inattention Symptoms in ADHD
The child often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).Inattention Symptoms in ADHD
The child often loses things necessary for tasks or activities (for example, toys, school assignments, pencils, books, or tools).Inattention Symptoms in ADHD
The child is often easily distracted by extraneous stimuli.Inattention Symptoms in ADHD
The child is often forgetful in daily activities.Hyperactivity Symptoms in ADHD
The child often fidgets with hands or feet or squirms in their seat.Hyperactivity Symptoms in ADHD
The child often leaves the seat in the classroom or in other situations in which remaining seated is expected.Hyperactivity Symptoms in ADHD
The child often runs about or climbs excessively in situations in which it is inappropriate.Hyperactivity Symptoms in ADHD
The child often has difficulty playing or engaging in leisure activities quietly.Hyperactivity Symptoms in ADHD
The child often talks excessively.Impulsivity Symptoms in ADHD
The child often blurts out answers before the questions have been completed.Impulsivity Symptoms in ADHD
The child often experiences difficulty awaiting his or her turn.Impulsivity Symptoms in ADHD
The child often interrupts or intrudes on others (for example, butts into conversations or games).Early recognition is key to treatment of ADHD
What should I do if I am concerned that my child might have ADHD?
Many of the symptoms of ADHD are also symptoms seen during normal childhood and development, and exhibiting one or more of the symptoms does not mean that a child has ADHD. In particular, the symptoms of ADHD are very common in toddlers and preschool children, so it can very hard to differentiate ADHD behaviors from normal developmental behaviors in young children. For this reason, the diagnosis of ADHD is more difficult in preschool children than in early school-aged children.
It is also important to note that for a health care professional to make a diagnosis of ADHD, the symptoms must have been present for at least six months in more than one setting (for example, home, school and in the community), usually beginning younger than seven years old and the symptoms must be inconsistent with the developmental level of the child and severe enough to interfere with the child's social or academic functioning.
If you are concerned about your child's behavior, it is appropriate to communicate this to your child's primary health care provider. He or she can help you determine whether further evaluation may be necessary and whether your child's behavioral symptoms are suggestive of ADHD. If a formal evaluation is indicated, this evaluation will involve professionals from various disciplines to provide a comprehensive medical, developmental, educational, and psychosocial evaluation.
What are some behavioral treatments and parenting strategies for parents of children with ADHD?
Think positively
While ADHD can certainly present unique and sometimes what can seem to be daunting challenges, being able to sincerely know and have confidence in your child's strengths can go a long way to help him or her be the very best person they can be. Many famous, accomplished, indeed brilliant people of the past and present have ADHD. An outstanding example of learning to have a positive outlook about ADHD is demonstrated in the children's movie called, Percy Jackson and the Olympians: The Lightening Thief. In that movie, Percy tends to see himself as disadvantaged because he has ADHD and a learning disability. However, it is the very tendency those conditions have to cause him to be able to notice many things at once and to read differently that are important assets to him in a variety of adventures.
Another benefit to thinking positively about your child with ADHD is its infectious nature. It is much easier for the child's teacher, coaches, peers and in fact the child his or herself to accept and harness strengths when the parent communicates and emphasizes those strengths. The challenge for parenting a child with ADHD is to be able to use the child's unique gifts and address his or her challenges to work towards achieving their child's fullest potential.
Define schedules and routines
Clearly defined schedules and routines are essential for children (as well as for teens and adults) with ADHD. Having an established, while not inflexible, pattern for getting ready in the mornings, preparing for bedtime, and managing after school homework and activities provides a sense of consistency and allows the child to know what to expect. It is also easier for the child to follow rules and routines when these do not vary very often. It can be helpful for older children to have plenty of conspicuous clocks to use as cues for time management. Some parents find that the use of timers (for homework time, time to finish up play, etc.) helps for younger children.
To make the process more enjoyable or easier to remember, charts and checklists can be used that list the steps or tasks required for each time of day. For example, the "morning checklist" can include items like making the bed, brushing teeth, and helping prepare school lunch. Hang the checklists in a conspicuous place and allow your child to check off completed items as they are done, if he/she wishes.
Set clear rules and expectations
As with clearly defined schedules, attainable, clearly defined rules and expectations are also essential for kids with ADHD. In both school and at home, children with ADHD need a consistent and clearly-defined set of rules. It can be helpful to create a list of rules for the home and post them in a place where the child can easily see them. It's very important to stick to the rules and provide fair and consistent rewards and consequences (see below) when the household rules are not followed.
Give clear instructions
Avoid vague or open-ended instructions such as "clean up your mess" or "play nicely" that do not accurately convey the specific tasks that you want to be done. Instead, use clear language and specific instructions such as "please put all the dirty clothes in the hamper," "please put all the toys back on the shelves," or "let's allow your friend to have a turn playing with the toy." Speak in a calm and clear voice and be sure to establish kind eye contact with your child when you give instructions so it is more likely he or she is focused on what you are saying. It can be helpful to have your child repeat the instructions back to you. Breaking down instructions for larger tasks into simple steps can also be helpful.
Discipline, rewards, and consequences
Children with ADHD respond very well to a defined and predictable system of rewards and consequences to manage behavior and discipline. Reward positive behaviors with praise or with small rewards that cost little or no money, such as special time with a parent or participating in an outing or favorite activity. Focus on praise or privileges as rewards rather than offering foods or toys as prizes. To avoid boredom and increase motivation, change the nature of the rewards periodically.
It's always best to give more rewards and positive praise than negative comments or consequences. For most parents, the number of negative comments made to their children is far greater than the number of positive comments, and this is particularly true of kids with ADHD, who are often exposed to endless criticism and complaints about their behavior. Remember to catch them being good. For example, smile and say "I like the way you're working on your homework" or "you're doing a great job clearing the table." Ask your child to say what they did well during and activity and help them come up with something if he or she cannot. Even though the positive behaviors may be expected or taken for granted in other children, praising and encouraging your child with ADHD when he or she exhibits positive or expected behavior will likely increase how often they show positive behaviors.
Likewise, consequences for negative behaviors should be fair, appropriate, consistent, predictable, and swiftly implemented and completed. Major events like holidays or the child's birthday should never be completely withdrawn or uncelebrated because of something the child did. Even the most severely acting out child needs to know that the day of their birth is a happy event for his or her parent. If the child impulsively opened presents or angrily broke something before a party, refusing to sing "Happy Birthday" for them is as unproductive as would be buying added gifts. Consequences should ideally be explained in advance and should occur immediately following the negative behavior. Delayed consequences (such as not participating in an event or outing in the following week) are not as effective as immediate consequences. Consequences can include time-out, removal from the situation or setting, or restriction of privileges. It is very important that the consequence occur after every instance of negative behavior. It's normal to feel angry when it seems as if your child is willfully misbehaving, but try to avoid the tendency to impose overly extreme consequences for minor violations. Small, repeated, and reasonable consequences have the greatest effect over the long term.
Use time-out effectively
Particularly for younger children, time-out can be an effective consequence for negative behaviors that serves the additional purpose of removing the child from an overstimulating or stressful environment. Time-out is also an immediate consequence that is likely to be more effective than a delayed consequence. Of course, time-out should never occur in a frightening or dangerous place for your child. If in public, try having time out for a few minutes in a quiet corner or in your car (with an adult present). Many experts recommend that time-outs not last longer in minutes than the child's age in years (for example, a five minute time out for a five year old). Longer than that may be too difficult for the child to complete, leading him or her to be more likely to defy doing the time out at all. That in turn will likely lead to a vicious cycle of parent and child frustration and therefore increasing conflicts. If your child is able, after the time-out, it can be useful to discuss or model the appropriate behavior for the given situation, asking or explaining to the child how the situation could have been handled more positively.
Ignore, within reason
In some situations, ignoring an undesired behavior may be an effective behavior modification technique for children with ADHD. Obviously, behavior that is risky or injurious to the child or to others cannot be ignored, but behaviors such as whining, nagging, and arguing can sometimes be best ignored until the behaviors stop. Many children with ADHD crave attention from others, even if it is negative attention in the form of yelling, shouting, or scolding. Refusing to provide any attention to the child who is behaving inappropriately can be effective if done consistently. For the child who gets increasingly loud or disruptive (escalates) when ignored, another way to respond may involve calmly and quietly telling the child that when they are calm and quiet the conversation can resume. For some children, the parent may need to remove themselves from the room as long as the child is safe to help the child calm down. Whenever the behavior stops, respond to the child as usual in a friendly, non-angry way
Develop organizational aids
Children with ADHD have poor executive functioning skills, which means, among other difficulties, that they have trouble organizing their belongings and tasks. Some parents (in cooperation with teachers) have found it helpful to provide color-coded binders and notebooks for each school subject, as well as a homework sheet in the front of the binder that lists homework for each school day. Others may find that purchasing a second set of textbooks for the home is useful for the child who frequently forgets to bring the proper materials home. Help your child develop an organizational system for his/her room and belongings and stick to it.
Of course, your home should be well-organized too. Modeling effective organization skills in front of your child can help him/her realize the importance and benefits of good organizational skills.
Eliminate distractions
While this sounds obvious, many home environments are simply chaotic and full of distractions for the child with ADHD. Be sure that your child has plenty of quiet time and space to complete homework and other tasks. A homework space that is free of external distractions like television, video games, or rooms in the home where most people congregate is key to successful completion of assignments.
Set small, attainable goals
Think of changing your child's less positive behaviors like training for a marathon. Just like no one would expect you or anyone else to go from never running at all to completing 26+ miles, it is unfair and unrealistic to expect your child to change 15, or 10 or even five behaviors immediately. Don't expect dramatic changes overnight. If your goal is to have your child sit still politely through a restaurant meal or family outing, break the process down into small and attainable goals like not interrupting a conversation for five minutes, remaining seated for ten minutes, etc. Be sure to offer plenty of praise and rewards when these small goals are met.
Focus on one or two challenging behaviors at a time
Changing all of a child's negative behaviors at once is never possible, and attempting to do so can create unbearable stress for both parent and child, setting both up for failure. Instead, pick one or two challenging behaviors that you'd like to improve and focus on those. Examples might be interrupting, not remaining seated, forgetting to put toys away, or arguing about bedtime. Whichever behaviors you choose to modify, understand the behavior changes must be gradual to be successful over time. Create a system of nonmonetary rewards and fair, swift consequences as described above and stick to it. You might offer the child a larger privilege or reward (for example, going to bed a half hour later one weekend night) when the behavior has been eliminated or significantly reduced (such as a complete week of putting away toys properly). Don't forget to praise the small successes along the way.
Find areas in which the child excels or succeeds
No one enjoys being subjected to constant criticism or complaints about their behavior. As every individual needs to feel good at something, constant criticizing can result in the child unwittingly working more at perfecting negative behaviors they get attention for rather than the positive behaviors if he or she is not praised.
Help your child find an area or interest in which he or she is successful. This can be a sport, music instrument, academic subject, art form, or other hobby. Even less defined strengths like getting along with their peers or adults can promote the child's success and are therefore worthy of praise. Being successful or having a strong interest in a hobby can greatly improve your child's self-esteem and well-being. Many parents have found that martial arts classes that combine physical movement with mental discipline training are helpful for their kids with ADHD. However, there is no single "best" activity for children with ADHD. Let their interests and enthusiasm be your guide.
Promote a healthy lifestyle
A healthy lifestyle will help not only your child but the entire family preserve both physical and emotional health. Stick to a nutrition plan and avoid giving your child junk foods and "empty" calories on more than an occasional basis. While sugary foods are not a cause of ADHD, some parents find that lots of sugary foods may worsen their child's symptoms. Sometimes older children with ADHD are so distracted and disorganized that they may skip meals or eat irregularly. Decreased appetite can be a side effect of some medications that treat ADHD. Try to ensure that your child is eating regularly, and small meals every few hours may be most effective for some children with ADHD. While allowing your child to enjoy childhood by allowing for an occasional treat, it is important to teach your child to make good food choices by modeling these choices yourself.
Exercise can help excitable children "burn off" excess energy, and regular exercise promotes physical well-being and healthy sleep habits. Encouraging your child to participate in organized sports after school can provide both regular exercise and the benefits of a regular and predictable schedule. As mentioned above, many children with ADHD do well in martial arts or yoga classes that emphasize mental as well as physical control over their bodies. In general, it's important to pick a sport that suits your child and his or her abilities, but sports that involve constant activity or motion may be better choices for some kids than sports that have significant "down-time" like baseball or softball.
Sleep is the final factor in ensuring a healthy lifestyle for your child and family on a daily basis. If your child is not well-rested, he/she will have even more difficulty staying focused and on-task. Falling asleep can be difficult for children with ADHD who may be overstimulated and have an increased activity level. As part of your regular and predictable schedule, it's important to have a set bedtime and bedtime routine. You can use a checklist or timer if you like to help your child make the transition to bedtime. Eliminating caffeine in your child's diet as well as providing a calming nighttime ritual (such as cuddling or sharing a book or story) can help your child wind down at the end of an active day. For older children and teens, turning off the computer and storing cell phones and other electronic devices outside the child's room for the night serve to prevent their interfering with sleep
Show your unconditional love
Be sure your child is aware of your unconditional love and support, no matter how he or she behaves. Withdrawal of love or affection is never an appropriate consequence for undesired behavior. It's OK to let your child know that you are angry or frustrated with his/her behavior at times, but remember to say "I love you" every day and be sure your child knows that he or she is an accepted and valued member of the family.
Take care of yourself
Finally, don't forget to take care of the caregiver. In addition to the joy of accomplishment, parenting a child with ADHD can bring on a variety of upsetting emotions including embarrassment, anger, anxiety, worry, and frustration. In fact, you may feel any or all of these on a given day. Try to keep a sense of perspective and understand that your child's behaviors are due to a disorder and may not always be under his or her full control.
Celebrating the small goals and positive steps in your child's progress and development will improve both your mood and your child's self-esteem. Don't lose sight of the special and unique individual that is your child, and find things you both enjoy to do together.
If you need a break, you shouldn't feel guilty. Parenting is a stressful job, and it's OK to accept help from family and friends in caring for your child. Take time off from parenting to spend time on activities you enjoy or even spend time alone in order to recharge yourself. You won't be an effective parent or role model if you have no energy to devote to the process.
Take advantage of all the resources that are at your disposal. If you don't know where to look, talk with your child's teacher, school counselor, or health care provider. School systems vary in the level of support they may be able to provide for parents and students with ADHD, but in all cases, parents and educators should work as a team to address the whole needs of the child. While the health and educational professionals you work with on your child's behalf have specific expertise, know and be confident in your unique expertise in knowing your child in ways no one else ever will. You are therefore your child's best advocate.
You may find that a therapist or support group may be helpful, for either you or your child. Many health care practitioners offer social skills and positive behavior workshops and classes for children that are geared toward having fun while learning to manage their condition. Your health care provider can also be a valuable resource and may have information about parent support groups or community resources
Attention Deficit Hyperactivity Disorder: ADHD in Adults
What Is Attention Deficit Hyperactivity Disorder (ADHD)?
Attention deficit hyperactivity disorder (ADHD) is one of the most well-recognized childhood developmental problems. This condition is characterized by inattention, hyperactivity and impulsiveness. It is now known that these symptoms continue into adulthood for about 60% of children with ADHD. That translates into 4% of the US adult population, or 8 million adults. However, few adults are identified or treated for adult ADHD.
ADHD in Adults
Adults with ADHD may have difficulty following directions, remembering information, concentrating, organizing tasks or completing work within time limits. If these difficulties are not managed appropriately, they can cause associated behavioral, emotional, social, vocational and academic problems.
Adult ADHD Stats
- ADHD afflicts approximately 3% to 5% of school-age children and an estimated 60% of those will maintain the disorder into adulthood.
- Prevalence rates for ADHD in adults are not as well determined as rates for children, but fall in the 1% to 5% range.
- ADHD affects males at higher rate than females in childhood, but this ratio seems to even out by adulthood.
Common Behaviors and Problems of Adult ADHD
The following behaviors and problems may stem directly from ADHD or may be the result of related adjustment difficulties:
- Chronic lateness and forgetfulness.
- Anxiety.
- Low self-esteem.
- Employment problems.
- Difficulty controlling anger.
- Impulsiveness.
- Substance abuse or addiction.
- Poor organization skills.
- Procrastination.
- Low frustration tolerance.
- Chronic boredom.
- Difficulty concentrating when reading.
- Mood swings.
- Depression.
- Relationship problems.
School-Related Impairments Linked to Adult ADHD
Adults with ADHD may have:
- Had a history of poorer educational performance and were underachievers.
- Had more frequent school disciplinary actions.
- Had to repeat a grade.
- Dropped out of school more often.
Work-Related Impairments Linked to Adult ADHD
Adults with ADHD are more likely to:
- Change employers frequently and perform poorly.
- Have had fewer occupational achievements, independent of psychiatric status.
Social-Related Impairments Linked to Adult ADHD
Adults with ADHD are more likely to:
- Have a lower socioeconomic status.
- Have driving violations such as: be cited for speeding; have their licenses suspended; be involved in more crashes; rate themselves and others as using poorer driving habits.
- Use illegal substances more frequently.
- Smoke cigarettes.
- Self-report psychological maladjustment more often.
Relationship-Related Impairments Linked to Adult ADHD
Adults with ADHD are more likely to:
- Have more marital problems and multiple marriages.
- Have higher incidence of separation and divorce.
How Is Adult ADHD Diagnosed?
While researchers may disagree about age of childhood onset in diagnosing adult ADHD, all agree that ADHD is not an adult-onset disorder and must be verified from childhood. An assessment of ADHD symptoms and behavior from childhood may include any or all of the following:
- A questionnaire to determine if the adult had ADHD in childhood.
- School report cards, if available, to look for comments about behavior problems, poor focus, lack of effort or underachievement relative to the student's potential.
- Discussion with the parents to determine any symptoms during childhood.
- A complete history from the adult with the symptoms. He or she may self report symptoms in childhood.
- The developmental history would be consistent with ADHD, including evidence of problems with peers, other delays such as bed wetting, school failure, suspensions, or special interventions such as sitting in front of the class, etc.
Other examinations may also be performed, including:
- A physical exam to rule out medical or neurological illness.
- An EEG, CT, or MRI.
- Psychoeducational testing (for example: IQ test, achievement testing) if a learning disability is suspected.
Medications to Treat Adult ADHD
The same drug treatments proven to be efficacious in children appear to benefit adults with ADHD.
In the past, the first treatment offered to adults with ADHD has been stimulant drugs. Studies show that approximately two thirds of adults with ADHD who are given these medications show significant improvement in ADHD symptoms.
However, there are some difficulties in using stimulants to treat ADHD in adults. Stimulants are controlled substances and it is not uncommon for adults with ADHD to have or to have had problems with substance abuse. Short acting stimulants may wear off quickly and since adult patients administer the medication themselves, and usually have problems with forgetfulness, compliance can be problematic with multiple day dosing. Adults may experience significant difficulty in the evening when they do housework, pay bills, help children with homework or drive, or are tempted to use substances 'to relax'. Learn more about Stimulant therapy for ADHD.
Strattera is the only nonstimulant medication approved by the Food and Drug Administration (FDA) for the treatment of ADHD, not just for children and adolescents, but for adults as well. This is the first medication to receive an FDA indication for treatment of ADHD in adults.
Strattera does not have abuse potential and does not require a special prescription.
Behavioral Treatments for Adult ADHD
Adult ADHD may be treated with one or more of the following:
- Individual cognitive and behavioral therapy to enhance self-esteem.
- Relaxation training and stress management to reduce anxiety and stress.
- Behavioral coaching to teach the person strategies for organizing home and work activities.
- Job coaching or mentoring to support better working relationships and improve on-the-job performance.
- Family education and therapy.
Psychosocial Behavior Management Strategies
Adults with ADHD can also benefit from some basic organizational concepts and behavior management strategies to help manage the condition. Here are ways to train yourself to overcome these problems or make them more manageable:
- Take medications as directed. If you are taking any medications for ADHD or any other condition, be sure and take them exactly as prescribed. Missing a dose or taking two doses at once to catch up on missed doses can have negative consequences for you and others. If you are noticing side effects or other problems, speak to your health care provider as soon as possible.
- Organize yourself. Train yourself to become more organized. Make lists of daily tasks (be reasonable!) and strive to complete them. Use a daily planner, leave notes for yourself and set your alarm clock when you need to remember an appointment or other activity.
- Control impulsive behavior. If you have a tendency to do things you later regret, such as interrupting or getting angry at others, manage the impulse by counting to 10 while breathing slowly instead of acting out. Usually the impulse will pass as quickly as it appeared.
- Minimize distractions. Find ways to reduce the distractions throughout the day. If you find yourself being distracted by loud music or the television, turn it off or use earplugs. Move yourself to a quieter location or ask others to help reduce distractions.
- Find constructive outlets for excess energy. People with ADHD sometimes seem to have more nervous energy than others, and this hyperactivity needs to have an outlet of some sort. A hobby or other pastime can be helpful.
- Ask for help. We all need help from time to time and it is important to not be afraid to ask for it when you need it. If you are having disruptive thoughts or behaviors, ask a counselor if they have any techniques that might help control them.
Living With Adult ADHD
Although most people don't outgrow ADHD, they do learn to adapt. If the difficulties associated with ADHD are managed appropriately throughout their lives, adults with ADHD can learn to develop personal strengths and become productive and successful.
source:medicinenet.com
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