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What is childhood ADHD (attention deficit hyperactivity disorder)?

Louise E. Sivak, MD
Pediatrics
Attention deficit hyperactivity disorder (ADHD) is a cognitive and behavioral condition that is thought to arise due to biochemical differences and/or connection problems in the so-called "executive functioning" center(s) in the brain. These areas are not yet fully structurally defined or localized, but most recent studies using functional MRI scans and other new modalities suggest that one key area in the prefrontal cortex. Symptoms vary among children but can include: poor concentration, difficulty focusing on tasks, fidgeting or increased movement, poor sleep, and difficulty organizing and prioritizing tasks. Coexistent learning "disabilities" and vision, hearing, and/or speech conditions must be tested for and excluded. Treatment consists of individualized therapy that includes behavioral strategies, strengthening communication between parents and teachers and pediatricians, addressing possible coexistent mental health issues and learning challenges, and sometimes the use of medication.
Childhood attention deficit hyperactivity disorder (ADHD) is a condition marked by impulsive, inattentive, and hyperactive behaviors. About 5% to 8% of children have ADHD, and many of these children will have ADHD symptoms as adults. Most people are born with the condition, although injuries can cause ADHD, too. There are many treatments for ADHD. The most effective treatment seems to be the combination of medication and behavioral therapy treatment.
Deborah Mulligan
Deborah Mulligan on behalf of MDLIVE
Pediatrics
The majority of childhood habits are so common that they should be considered normal.  Sometimes parents find it hard to know whether a condition needs attention or not.  Children usually grow out of their behavioral problems or their peculiar habits, but some disorders, such as attention deficit hyperactivity disorder (ADHD) require expert help.  

ADHD is a common behavioral disorder that affects an estimated 8% to 10% of school-age children. Boys are about three times more likely than girls to be diagnosed with it, though it's not yet understood why.  Children with ADHD act without thinking, are hyperactive, and have trouble focusing. They may understand what's expected of them but have trouble following through because they can't sit still, pay attention, or attend to details.

All children act this way at times, particularly when they're anxious or excited, but the difference with ADHD is that symptoms are present over a longer period of time and occur in different settings. They impair a child's ability to function socially, academically, and at home.

It is not known why children have ADHD, but some possible causes may be genetic factors and environmental influences.  If you think your child may have ADHD, consult your pediatrician to determine if an evaluation is needed.  ADHD is the most researched of all childhood behavioral disorders.  The diagnosis of ADHD is based on strict criteria set by the American Psychiatric Association.  Children must meet the criteria before being appropriately diagnosed with ADHD.  The American Academy of pediatrics recommends that all children referred for an ADHD evaluation have a thorough assessment, with observations of behavior by parents, teachers, and other caregivers.

Children diagnosed with ADHD are "just emotionally neglected. Their mothers are exhausted and burned out from long hours at work, and these kids spend way too much time in child care," wrote a responder to an article on attention – deficit/hyperactivity disorder (ADHD) on the New York Times website. This and similar views – that kids with ADHD are really just naughty, spoiled troublemakers – are widespread. But they are also "antiquated, anachronistic, and wrong," says Bradley Peterson, a psychiatrist at NewYork-Presbyterian's Columbia University Medical Center campus.

Dr. Peterson's recent research shows that kids who develop ADHD have real, consistent physiological differences from other kids. Using magnetic resonance imaging (MRI) and anatomical mapping techniques, Dr. Peterson and his colleagues found that the brains of children with ADHD have anatomical abnormalities including an enlarged hippocampus, the part of the brain that deals with memory, emotions, and spatial orientation, and a smaller frontal cortex, the brain region responsible for personality, decision-making, and social behavior.

These structural differences contribute to significant abnormalities along the brain circuit "that we think is really important for controlling motor activity and unwanted impulses." Stimulant medications commonly used to treat ADHD can alter these anatomical abnormalities, Dr. Peterson says, and seem to normalize this circuit.

The hallmarks of ADHD are behavioral problems including inattention, distractibility, impulsivity, and hyperactivity. "When children with ADHD are not taking stimulant medication, they are unable to suppress the mind-wandering circuits - but when they take the stimulant medication, they are able to shut these off," said Dr. Peterson. "Medication seems to normalize the neural systems that either permit or suppress mind-wandering."

Researchers don't know how stimulant medication changes brain anatomy, he continued, "but we believe it affects activity within nerve cells, and ultimately alters gene expression and the proteins that determine brain structure." Using an array of new magnetic resonance imaging techniques (functional magnetic resonance imaging [fMRI], diffusion tensor MRI, and magnetic resonance spectroscopy), he has been able to show improved brain function in children being treated with medications for ADHD.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.