Attention Deficit Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADD/ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development exhibited by deficits in performance at school, home, and in social relationships. ADHD typically begins in childhood years, with several symptoms being present before the age of 12. The symptoms of inattention and/or hyperactivity need to manifest themselves in a manner and degree which is inconsistent with the child’s current developmental level. That is, the child’s behavior is significantly more inattentive or hyperactive than that of his or her peers of a similar age. In addition, a person can present with predominantly inattention, predominantly hyperactivity-impulsivity, or a combination of the two (see below symptoms).

Symptoms of Inattention:
  • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
  • Often has difficulty sustaining attention in tasks or playactivities
  • Often does not seem to listen when spoken to directly
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
  • Often has difficulty organizing tasks and activities
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
  • Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
  • Is often easily distracted by extraneous stimuli
  • Is often forgetful in daily activities–even those the person performs regularly (e.g., a routine appointment)

Symptoms of Hyperactivity/Impulsivity:
Hyperactivity
  • Often fidgets with hands or feet or squirms in seat
  • Often leaves seat in classroom or in other situations in which remaining seated is expected
  • Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
  • Often has difficulty playing or engaging in leisure activities quietly
  • Is often “on the go” or often acts as if “driven by a motor”
  • Often talks excessively
Impulsivity
  • Often blurts out answers before questions have been completed
  • Often has difficulty awaiting turn
  • Often interrupts or intrudes on others (e.g., butts into conversations or games)
Symptoms must have persisted for at least 6 months. Some of these symptoms need to have been present as a child, at 12 years old or younger. The symptoms also must exist in at least two separate settings (for example, at school and at home). The symptoms should be creating significant impairment in social, academic or occupational functioning or relationships.

Possible Causes of Childhood ADHD

Genes
ADHD appears to have some type of genetic basis in the majority of cases, as a child with ADHD is four times as likely to have had a relative who was also diagnosed with attention deficit disorder. At the moment, researchers are investigating many different genes, particularly ones involved with the brain chemical dopamine. People with ADHD seem to have lower levels of dopamine in the brain.

Nutrition & Food
Certain components of the diet, including food additives and sugar, appear to have clear effects on a child’s or teen’s behavior. But appearances can be deceiving.
However, the belief that sugar is one of the primary causes of attention deficit disorder does not have strong support in the research data. While some older studies did suggest a link, more recent research does not show a link between ADHD and sugar. While the jury is still out on whether sugar can contribute to ADHD symptoms, most experts now believe that the link is not a strong one. Simply removing sugar from a child’s diet is unlikely to significantly impact their ADHD behavior.

Some studies also suggest that a lack of omega-3 fatty acids is linked to ADHD symptoms. These fats are important for brain development and function, and there is plenty of evidence suggesting that a deficiency may contribute to developmental disorders including ADHD. Fish oil supplements appear to alleviate ADHD symptoms, at least in some children, and may even boost their performance at school. Some experts believe that food additives may also exacerbate ADHD.

The Child or Teen’s Environment
There may be a link between ADHD and maternal smoking. However,women who suffer from ADHD themselves are more likely to smoke, so a genetic explanation cannot be ruled out. Nevertheless, nicotine can cause hypoxia (lack of oxygen) in utero.

Lead exposure has also been suggested as a contributor to ADHD. Although paint no longer contains lead, it is possible that preschool children who live in older buildings may be exposed to toxic levels of lead from old paint or plumbing that has not been replaced.

Brain Injury
Brain injury may also be a cause of attention deficit disorder in some very small minority of children. This can come about following exposure to toxins or physical injury, either before or after birth. Experts say that head injuries can cause ADHD-like symptoms in previously unaffected people, perhaps due to frontal lobe damage.

Risk Factors for ADHD

There are a number of things that may put a child or teen at greater risk for being diagnosed with attention deficit hyperactivity disorder. These include:
  • Someone in their family (such as a brother or sister, or parent, or grandparent) having ADHD or another mental disorder.
  • Maternal drug use or smoking during pregnancy.
  • Premature birth.
  • Maternal exposure to environmental poisons — such as polychlorinated biphenyls (PCBs) — during pregnancy
  • Environmental toxins, such as lead (found in peeling paint in older buildings) or being exposed to second-hand smoke.
Note that sugar does not have good research data supporting its relationship with ADHD.