Note: I’ve divided this extensive article into a number of smaller posts. You may read this article in its entirety here: What is ADHD? – NIMH
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity). These symptoms can make it difficult for a child with ADHD to succeed in school, get along with other children or adults, or finish tasks at home.
Brain imaging studies have revealed that, in youth with ADHD, the brain matures in a normal pattern but is delayed, on average, by about 3 years.1 The delay is most pronounced in brain regions involved in thinking, paying attention, and planning. More recent studies have found that the outermost layer of the brain, the cortex, shows delayed maturation overall,2 and a brain structure important for proper communications between the two halves of the brain shows an abnormal growth pattern.3 These delays and abnormalities may underlie the hallmark symptoms of ADHD and help to explain how the disorder may develop.
Treatments can relieve many symptoms of ADHD, but there is currently no cure for the disorder. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.
Genes. Inherited from our parents, genes are the “blueprints” for who we are. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder.4,5 Knowing the genes involved may one day help researchers prevent the disorder before symptoms develop. Learning about specific genes could also lead to better treatments.
A study of children with ADHD found that those who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved.6
Researchers are also studying genetic variations that may or may not be inherited, such as duplications or deletions of a segment of DNA. These “copy number variations” (CNVs) can include many genes. Some CNVs occur more frequently among people with ADHD than in unaffected people, suggesting a possible role in the development of the disorder.7,8
Environmental factors. Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children.9,10 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, have a higher risk of developing ADHD.11
Brain injuries. Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.
Sugar. The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it.12 In one study, researchers gave children foods containing either sugar or a sugar substitute every other day. The children who received sugar showed no different behavior or learning capabilities than those who received the sugar substitute.13 Another study in which children were given higher than average amounts of sugar or sugar substitutes showed similar results.14
In another study, children who were considered sugar-sensitive by their mothers were given the sugar substitute aspartame, also known as Nutrasweet. Although all the children got aspartame, half their mothers were told their children were given sugar, and the other half were told their children were given aspartame. The mothers who thought their children had gotten sugar rated them as more hyperactive than the other children and were more critical of their behavior, compared to mothers who thought their children received aspartame.15
Food additives. There is currently no research showing that artificial food coloring causes ADHD. However, a small number of children with ADHD may be sensitive to food dyes, artificial flavors, preservatives, or other food additives. They may experience fewer ADHD symptoms on a diet without additives, but such diets are often difficult to maintain.12,16
Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in children and adolescents. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and very high levels of activity. Studies show that the number of children being diagnosed with ADHD is increasing, but it is unclear why.
ADHD was seen as a behavioral disturbance caused by environmental factors, such as inconsistent parenting.
Methods to study brain development in people with ADHD were not available.
ADHD was treated with immediate-release stimulant medications such as methylphenidate (e.g., Ritalin), which worked well but only lasted for a few hours. Children needed multiple doses during the day, disrupting their school schedules and daily activities.
Using brain imaging technology like magnetic resonance imaging (MRI), scientists have observed that in some children, ADHD may be related to how the brain is wired or how it is structured. For other children with ADHD, brain development follows a normal but delayed pattern. In some regions, development is delayed by an average of three years compared to children without the disorder.
The delay appears to be in the frontal cortex, a part of the brain that supports the ability to suppress inappropriate actions and thoughts, focus attention, remember things moment to moment, work for reward, and plan ahead. In contrast, the motor cortex—the area that controls movement—tends to mature faster than normal in children with ADHD, an exception to the pattern of delay. This mismatch in brain development may account for the restlessness and fidgety symptoms commonly associated with ADHD.
Findings from the Preschoolers with ADHD Treatment Study (PATS) indicate that using a very low dose of methylphenidate (e.g., Ritalin) to treat children 3–5 years old diagnosed with severe ADHD can be effective. However, for some very young children, early behavioral interventions designed to reduce their ADHD symptoms may be effective alternatives or additions to medication treatment.
Preschoolers with fewer than three coexisting disorders were most likely to respond to methylphenidate treatment, whereas those with three or more coexisting disorders did not respond to the treatment.
Different types of psychotherapy are effective in treating ADHD. Behavioral therapy helps teach practical skills such as how to organize tasks and manage time to complete homework assignments. It also helps children work through difficult emotions. Therapists also teach children social skills such as how to wait their turn, share toys, ask for help, or respond to teasing.
Studies show that interventions that include intensive parent education programs can help decrease ADHD problem behavior because parents are better educated about the disorder and better prepared to manage their child’s symptoms. They are taught organizational skills and how to develop and keep a schedule for their child. They are also taught how to give immediate and positive feedback for behaviors they want to encourage, and how to ignore or immediately redirect behaviors they want to discourage.
The Multimodal Treatment Study of Children with ADHD (MTA study) is helping to inform long-term treatment decisions. For example, MTA researchers found that medication works best when treatment is regularly monitored by the prescribing doctor and the dose is adjusted based on the child’s needs. As children with ADHD mature, treatment decisions should adapt to the demands of adolescence and take into account long-term academic and behavioral problems commonly associated with ADHD.
ADHD likely stems from interactions between genes and environmental or non-genetic factors. Several genes have been implicated in the risk for developing ADHD. One study showed that brain areas controlling attention were thinnest in children with ADHD who carried a particular version of a gene associated with brain development. However, these brain areas normalized in thickness during the teen years, coinciding with clinical improvement. Although this particular gene version increased risk for ADHD, it also predicted better clinical outcomes and higher IQ than two other versions of the same gene in youth with ADHD.
Research continues in the search for innovative methods to treat ADHD and may someday offer more options for children who cannot take stimulant medications or who do not respond to them. For example, researchers are looking for ways to improve psychosocial treatments that combine behavioral and cognitive therapies.
Other research is focused on neurofeedback, an activity in which a person receives information about the frequency of his or her EEG brain waves while undergoing a task such as playing a video game. The person can then be trained to bring these frequencies into a range associated with healthy brain function, which theoretically can lead to improved behavior.
ADHD symptoms may decline for some children as they grow up. But others may face continuing problems. A recent study found that adults with untreated ADHD have higher than average rates of divorce, unemployment, substance abuse, and disability. Also, while many adults with ADHD receive treatment for other mental disorders or substance abuse, a smaller proportion receive treatment for their ADHD symptoms.
More studies are needed to assess the effects of ADHD over the lifespan and to find better ways to diagnose and treat ADHD in adults, with a special focus on improving functioning.
“Image courtesy of Stuart Miles/FreeDigitalPhoto.net” Modified on Canva.com
ADD websites Non-profits Starter Information Popular sites
“The most important things we can offer Children & Adults with ADHD are: Love, Acceptance, Respect & Empathy… In the absence of these things, all of the Other things you do are unimportant” – Sam Goldstein
Center for Disease Control and Prevention – ADHD section. Attractive, ADD-Friendly format- complete, but concise- offers basic information about ADHD and children, but provides links to help you find out more. (Mostly to CHADD or the National Resource Center)
National Resource Center on ADHD: a Program of CHADDis the nation’s clearinghouse for science-based information about all aspects of attention-deficit/hyperactivity disorder (ADHD). Funded by the Centers for Disease Control and Prevention, the NRC provides information on this disorder which affects how children and adults function on a daily basis. www.help4adhd.org – The National Resource Center also provides a series of information sheets on AD/HD. See the complete list of the What We Know (WWK) printouts. Note: You can email or talk to a resource specialist to get personalized help.
CHADD –CHADD stands for Children and Adults with ADHD. CHADD has a national headquarters and approximately 200 local chapters that hold monthly meetings and offers a professional directory (with paid listings.) They provide a wealth of free information on both their own site and link to The National Resource Center for ADHD for even more. CHADD National puts on a large annual international conference and publishes the bi-monthly magazine Attention – (One of many membership benefits which include access to their many members-only articles) Free monthly e-news.
ADDA– ADDA stands for the National ADD Association for Adults. They send out e-mails to keep you up-to-date and feature a Professional Directory. Collecting personal stories from readers and offering Virtual Peer Support. Webinars are Free for Members ($50 a year or $5 a month) or $10 each.
Help4Kids– Great site developed by Tufts University to help families, teachers, children, and clinicians find answers to some of their questions about ADHD. Each section is set up in a question-answer format so you can either read through all of the information in that section or look up answers to your specific questions only. They also link to other sites for additional information.
Healthy Children’s ADHD section features a number of articles from 3 paragraphs to 3 pages long. Topics cover a number of general as well as more specific concerns for ages 3-18 – From the American Pediatrics Association
Kids Health -The #1 most-visited website for children’s health and development. – The Nemours Foundation sponsors a website for Parents, Kids and Teens – each has their own section. Covers any and all aspects of children’s health concerns. Available in Spanish and you may add audio to most articles if reading is a problem. Use the Search option- Just type in ADHD– or just start browsing for other concerns.
ADHD Resource Center from the American Academy of Child and Adolescent Psychiatrists – Includes Facts for Families with up-to-date information, video clips plus an eBook.
Children and Adults
Help Guide.org is a site founded by the Rotary Club International. They have a quite a good ADHD section, but they also address MANY other concerns of modern life – Mental and Emotional Life, Family and Relationships, Healthy Living, Seniors, and Aging. Note – Help Guide offers an unusual, but possibly transformative feature- The Emotional Intelligence ControlCourse
ADDitude.mag– A complete site sponsored by ADDitude magazine, a national bi-monthly magazine for the ADHD community. Short, pertinent articles address a host of AD/HD concerns. Learn about family support options for Attention Deficit Disorder as well as many topics specific to adult issues. Just added a Networking section to their site – with Forums, Blogs, Videos and listings for nationwide ADHD events – Great e-newsletter
ADD About.com – Keath Lowe moderates the site, keeps a Blog, sponsors a Forum and expands the site every day- Up to date and easy to read- Their Coping with ADHD section has a wonderful selection of on-point and useful information.
Totally ADD! for adults – Some pretty good Information and a lot of just plain fun. Quick videos address a number of common concerns of adults with ADD. Blog and ADHD screening tools- Constantly adding more videos and now providing FREE Webcasts– (recorded and available for view anytime)
ADDvance.com – Answers to your Questions about ADD(ADHD) with Patricia Quinn, MD and Kathleen Nadeau, Ph.D. Offers insightful, yet practical information addressed to many different ADD audiences, although women and girls receive special attention. (Note: Many articles formerly posted on the site have been “packaged” according to topic and downloads are available to purchase.) They do offer a Free “ADD-Friendly Living” e-newsletter.
Health Central.com / ADHD Central– Hosted by Elaine Bailey, long time moderator for AboutADD.com, this site offers a number of articles covering a variety of topics for all ages, a few interactive learning opportunities, some videos and a Community Forum. (I like the Share-Post section) Use the top bar to navigate the site for specific topics and features.
Web MD has a large section devoted to ADHD. Copy and paste: http://www.webmd.com/add-adhd/default.htm – They offer a very well organized and informative overview of the disorder. Articles are generally short and somewhat impersonal, but they’ve tried to cover it all. They even have Videos (prefaced with short ads- indeed many videos are advertisements themselves for supplemental treatments), keep up- to-date on ADHD news and monitor an online community.
Healthy Place.com – Another good starting place- ADHD section addresses a number of common concerns and needs. Most are short, introductory articles, but they cover a number of topics.
ADHD – ADD freeSources on Pinterest – Over 15,000 Pins featuring articles, images and other commentary on ADHD and related topics. 60 boards offer information for parents, adults with ADHD, professionals as well as for children and teens.
1) ADHD is Real.
Nearly every mainstream medical, psychological, and educational organization in the United States long ago concluded that Attention-Deficit/Hyperactivity Disorder (ADHD) is a real, brain-based medical disorder. These organizations also concluded that children and adults with ADHD benefit from appropriate treatment. (1, 2, 3, 4, 5, 6, 7)
2) ADHD is a Common, Non-Discriminatory Disorder.
ADHD is a non-discriminatory disorder affecting people of every age, gender, IQ, religious and socio-economic background. In 2011, the Centers for Disease Control and Prevention reported that the percentage of children in the United States who have ever been diagnosed with ADHD is now 9.5%.(8) Boys are diagnosed two to three times as often as girls. Among adults, the Harvard/NIMH National Comorbidity Survey Replication found 4.4% percent of adults, ages 18-44 in the United States, experience symptoms of ADHD and some disability.(9) ADHD, AD/HD, and ADD all refer to the same disorder. The only difference is that some people have hyperactivity and some people don’t.
3) Diagnosing ADHD is a complex process.
In order for a diagnosis of ADHD to be considered, the person must exhibit a large number of symptoms, demonstrate significant problems with daily life in several major life areas (work, school, or friends), and have had the symptoms for a minimum of six months. To complicate the diagnostic process, many of the symptoms look like extreme forms of normal behavior. Additionally, a number of other conditions resemble ADHD. Therefore, other possible causes of the symptoms must be taken into consideration before reaching a diagnosis of ADHD. What makes ADHD different from other conditions is that the symptoms are excessive, pervasive, and persistent. That is, behaviors are more extreme, show up in multiple settings, and continue showing up throughout life. No single test will confirm that a person has ADHD. Instead, diagnosticians rely on a variety of tools, the most important of which is information about the person and his or her behavior and environment. If the person meets all of the criteria for ADHD, (10, 11) he or she will be diagnosed with the disorder.
4) Other Mental Health Conditions Frequently Co-Occur with ADHD.
• Up to 30% of children and 25-40% of adults with ADHD have a co-existing anxiety disorder.(12 )
• Experts claim that up to 70% of those with ADHD will be treated for depression at some point in their lives. (13)
• Sleep disorders affect people with ADHD two to three times as often as those without it. (14)
5) ADHD is Not Benign. (15)
Particularly when the ADHD is undiagnosed and untreated, it contributes to:
• Problems succeeding in school and successfully graduating. (16, 17)
• Problems at work, lost productivity and reduced earning power. (18, 1,9 20, 21)
• Problems with relationships. (22, 23)
• More driving citations and accidents. (24, 25, 26, 27)
• Problems with overeating and obesity. (28, 29, 30, 31)
• Problems with the law. (32, 33) According to Dr. Joseph Biederman, professor of psychiatry at Harvard Medical School, ADHD may be one of the costliest medical conditions in the United States: “Evaluating, diagnosing and treating this condition may not only improve the quality of life, but may save billions of dollars every year.” (34)
6) ADHD is Nobody’s FAULT.
ADHD is NOT caused by any moral failure, poor parenting, family problems, poor teachers or schools, too much TV, food allergies, or excess sugar. Instead, research shows that ADHD is both highly genetic (with the majority of ADHD cases having a genetic component), and a brain-based disorder (with the symptoms of ADHD linked to many specific brain areas). (35)The factors that appear to increase a child’s likelihood of having the disorder include gender, family history, prenatal risks, environmental toxins, and physical differences in the brain. (36)
7) ADHD Treatment is Multi-Faceted.
Currently, available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, behavioral interventions, education or training, and educational support. Usually, a person with ADHD receives a combination of treatments. (37, 38)
Your “Presence” Parent Coaching Tip from Elaine Taylor-Klaus of ImpactADHD.com – Nothing matters more than honestly “being present” and interacting with your child with loving attention and conversation. (1 1/2 minutes)
ADHD Help: Adventure into the ADD Brain – Overcoming chaos. Explains why ADHD kids have such a great need for order, routines and control over their environment. From Chaos to Calm (2 1/2 minutes)
Changing “Deviant” Behavior You’ve come a long way baby. Or have we? Video clip created from an “educational” film who’s purpose was to change the behavior of teenage girls who did not meet proper behavior standards of the day. Always running late, being messy or otherwise disorganized and interrupting others is seen as “deviant.” Uses shame as a motivating force for changing those “bad habits.” (2 minutes)
What Is Parent-Child Interaction Therapy? (PCIT) 1 ½ minute video on this effective style of Parent Training – From the Child Mind Institute. Parents and children together learn techniques to rein in behavior.
Kids in the House with Edward Hallowell, M.D. – Explaining ADHD to Kids is just one of forty-seven short videos with Hallowell, a specialist in ADHD and other learning differences. Deals with diagnosis, navigating medication and the power of connection. (Note: Must be a member of Kids in the House to access more than 1 video, but membership is free.)
ADHD section on Kids in the House Over 80 short videos from specialists on all aspects of ADHD in children. (As noted above, you must become a member to watch more than 1 – FREE)
Can’t attend an ADHD conference? You can still learn about ADHD from experts in the field. Best of all, you can view them on your own time and for no charge.
*Best of the Web –CADDAC 2009 ADHD Conference videos – A wonderful gift from – The Centre for ADD/ADHD Advocacy of Canada- (CADDAC) Choose from a number of presentations filmed over both days. You’ll find the list at this link.
The 30 Essential Ideas Every Parent Needs to Know (about ADHD), by Dr. Russell Barkley
This is the 3-hour video presentation from the CADDAC conference (found above), broken up into 27 manageable parts with an average length of 6 to 7 minutes. It’s far easier to watch. To take a saying from Barkley, “Small Chunks, Frequent Breaks.”
ADHD Neurology and Genetic Research 6 short videos with Professor Philip Shaw from NIH (National Institute of Health) – Makes difficult concepts more readily understandable. Our thanks to Mungosadhd.com
You, Me and Adult ADD with Gina Pera – 3 clips containing Gina’s talk for CADDRA’s 2009 Conference. Find on Mungo’s Vimeo Channel
Classroom Interventions for ADHD Video with Russell Barkley (3 ½ minutes)
ADHD: Undiagnosed in Millions, Do You Have it? (4 minutes) Alan Brown gives us a call to action to be advocates to bring awareness and attention to ADHD so individuals do not fall through the cracks and have the safety net they need to succeed.