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JAMA Patient Page
May 1, 2013

Attention-Deficit/Hyperactivity Disorder

JAMA. 2013;309(17):1843. doi:10.1001/jama.2013.803

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental (related to brain function) condition that is usually diagnosed in childhood. It can last into adulthood. Symptoms include difficulty staying focused or paying attention, excess motor activity (eg, fidgeting), and difficulty controlling impulsive behavior. Although most children have these problems some of the time, the diagnosis is made when these symptoms are more severe and persistent than is expected for the child's age and developmental level. It is important to know that ADHD is a biological condition and not due to poor parenting or a child having bad behavior on purpose. ADHD has different subtypes. Some people have hyperactivity and impulsivity as well as trouble paying attention; other people have mostly symptoms of inattention. Although they may sit quietly, such individuals are not paying attention when they need to, such as in school or while doing homework. Among these people, the diagnosis of ADHD may be missed or delayed.

SYMPTOMS

Symptoms of ADHD may include

Inattention

  • Problems focusing

  • Not paying attention to details or making careless mistakes

  • Being distracted or bored easily

  • Being forgetful and losing things

  • Not finishing tasks

  • Daydreaming

Hyperactivity

  • Fidgeting and restless

  • Talking too much

  • Running around or moving when not appropriate for the situation

Impulsivity

  • Impatience

  • Interrupting often

  • Acting before thinking

DIAGNOSIS

The diagnosis of ADHD is made by evaluating the frequency and severity of several symptoms together and also whether the person is not doing as well at school or work or getting along with other people as would be expected. To be significant, a symptom must have started before age 7 years, be present for at least 6 months, and not be due to another cause. The pediatrician or mental health specialist will find out about behavior at home and school as well as performance at school or work. Other problems that can lead to similar symptoms include impaired hearing or vision, learning disabilities, or temporary reactions to difficult events such as the loss of a parent or parents' divorce.

TREATMENT

Some people respond well to medication. The most common medication used is a stimulant. Even though this seems strange, the stimulant helps the parts of the brain involved in focusing attention and resisting impulses. There are many different forms of stimulants, and a person may react better to one than to another. Side effects may include decreased appetite, problems sleeping, or headaches and stomachaches. The doctor will watch for more rare side effects as well. Some people may be helped by behavioral therapy. Neither medication nor behavior modification cure ADHD, but they do help manage the symptoms and help the person to be successful. Dietary treatments (such as limiting sugar) do not have scientific evidence that they work.

SCHOOL FUNCTIONING

Your child's teacher may be the first to notice that there are problems in learning, completing work, or behavior. The school can help get an evaluation and provide special services if your child needs them.

PROGNOSIS

Sometimes hyperactivity decreases with age. Other times the diagnosis is not made until adolescence or adulthood, although the disorder began in childhood. Research to identify the underlying cause (including the possible role of genes or brain development) may lead to new therapies. Most people with ADHD can lead independent, productive lives.

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page index on JAMA's website at www.jama.com. Many are available in English and Spanish.

Sources: National Institute of Mental Health, Centers for Disease Control and Prevention, American Academy of Pediatrics

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Topic: MENTAL HEALTH AND BEHAVIOR

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