Q. What is Attention Deficit Hyperactivity Disorder (ADHD)?

Q. What is the history of ADHD? How is it related to ADD?

Q. What are the symptoms of ADHD?

Q. How is ADHD diagnosed?

Q. How many children are diagnosed with ADHD?

Q. Aren't there various types of ADHD?

Q. How are schools involved in diagnosing, assessing, and treating ADHD?

Q. Is ADHD inherited?

Q. Is ADHD on the increase? If so, why?

Q. Can a preschool child be diagnosed with ADHD?

Q. What is the impact of ADHD on children and their families?

Q. Aren't there nutritional treatments for ADHD?

Q. How do I try to maintain good behaviour?

Q. What medications are currently being used to treat ADHD?

Q. Are there standard doses for these medications?

Q. How long are children on these medications?

Q. How often are stimulant prescriptions used?

A. Data from 1995 show that physicians treating children and adolescents wrote six million prescriptions for stimulant medications—methylphenidate (Ritalin®) and dextroamphetamine (Dexedrine®). Of all the drugs used to treat psychiatric disorders in children, stimulant medications are the most thoroughly studied.

Q. Isn't stimulant use on the increase?

A. Stimulant use in the United States has increased substantially over the last 25 years. A recent study saw a 2.5-fold increase in methylphenidate between 1990 and 1995. This increase appears to be largely related to an increased duration of treatment, and more girls, adolescents, adults, and inattentive individuals (in addition to those individuals with both hyperactivity and inattentiveness/attention deficit) receiving treatment.

Q. Are there differences in stimulant use across racial and ethnic groups?

A. There are significant differences in access to mental health services between children of different racial groups; and, consequently, there are differences in medication use. In particular, African American children are much less likely than Caucasian children to receive psychotropic medications, including stimulants, for treatment of mental disorders.

Q. Why are stimulants used when the problem is overactivity?

A. The answer to this question is not well established, but one theory suggests that ADHD is related to difficulties in inhibiting responses to internal and external stimuli. Evidence to date suggests that those areas of the brain thought to be involved in planning, foresight, weighing of alternative responses, and inhibiting actions when alternative solutions might be considered, are underaroused in persons with ADHD. Stimulant medication may work on these same areas of the brain, increasing neural activity to more normal levels. More research is needed, however, to firmly establish the mechanisms of action of the stimulants.

Q. What are the risks of the use of stimulant medication and other treatments?

A. Stimulant drugs, when used with medical supervision, are usually considered quite safe. Although they can be addictive when abused by teenagers and adults, when taken as prescribed for ADHD these medications have not been shown to be addictive nor to lead to substance abuse problems. They seldom make children "high" or jittery, nor do they sedate the child. Although little information exists concerning the long-term effects of psychostimulants, there is no evidence that careful therapeutic use is harmful. When adverse drug reactions do occur, they are usually related to dosage and are always reversible. Effects associated with moderate doses are decreased appetite and insomnia. These effects occur early in treatment and may decrease with time. There may be negative effects on growth rate, but ultimate height appears not to be affected.

Q. Will children taking these medications for ADHD become drug addicts?

A. Actually, it appears to be just the opposite. Although an increased risk of drug abuse and cigarette smoking is associated with childhood ADHD, this risk appears mostly due to the ADHD condition itself, rather than its treatment. In a study jointly funded by the NIMH and the National Institute on Drug Abuse, boys with ADHD who were treated with stimulants were significantly less likely to abuse drugs and alcohol when they got older. Caution is warranted, nonetheless, as the overall evidence suggests that persons with ADHD (particularly untreated ADHD) are indeed at greater risk for later alcohol or substance abuse. Because some studies have come to conflicting conclusions, more research is needed to understand these phenomena. Regardless, in view of the substantial, well-established findings of the harmful effects of inadequate or no treatment for a child with ADHD, parents should not be dissuaded from seeking effective treatments because of misconstrued or exaggerated claims about substance abuse risks.

Q. What is the relationship between ADHD and other disorders, such as learning disabilities, anxiety disorders, bipolar disorder, or depression?

A. Comorbidity occurs in most children clinically treated for ADHD. ADHD can co-occur with learning disabilities (15-25%), language disorders (30-35%), conduct disorder (15-20%), oppositional defiant disorder (up to 40%), mood disorders (15-20%), and anxiety disorders (20-25%). Up to 60 percent of children with tic disorders also have ADHD. Impairments in memory, cognitive processing, sequencing, motor skills, social skills, modulation of emotional response, and response to discipline are common. Sleep disorders are also more prevalent.

Q. What are the future research directions for ADHD?

A. Continued research on ADHD is needed from many perspectives. The societal impact of ADHD needs to be determined. Studies in this regard include (1) strategies for implementing effective medication management or combination therapies in different schools and pediatric healthcare systems; (2) the nature and severity of the impact on adults with ADHD beyond the age of 20, as well as their families; and (3) determination of the use of mental health services related to diagnosis and care of persons with ADHD. Additional studies are needed to improve communication across educational and health care settings to ensure more systematized treatment strategies. Basic research is also needed to better define the behavioral and cognitive components that underpin ADHD, not just in children with ADHD, but also in unaffected individuals. This research should include (1) studies on cognitive development, cognitive and attentional processing, impulse control, and attention/inattention; (2) studies of prevention/early intervention strategies that target known risk factors that may lead to later ADHD; and (3) brain imaging studies before the initiation of medication and following the individual through young adulthood and middle age. Finally, further research should be conducted on the comorbid (coexisting) conditions present in both childhood and adult ADHD, and treatment implications.