ADHD – Attention Deficit/Hyperactivity

Scientists are studying cause(s) and risk factors in an effort to find better ways to manage and reduce the chances of a person having ADHD. The cause(s) and risk factors for ADHD are unknown, but current research shows that genetics plays an important role. Recent studies of twins link genes with ADHD.¹

In addition to genetics, scientists are studying other possible causes and risk factors including:

• Brain injury
• Environmental exposures (e.g., lead)
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. Of course, many things, including these, might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

For more information about cause(s) and risk factors, visit the National Resource Center on ADHD or the National Institute of Mental Health.

In most cases, ADHD is best treated with a combination of behavior therapy and medication. For preschool-aged children (4-5 years of age) with ADHD, behavior therapy is recommended as the first line of treatment. No single treatment is the answer for every child and good treatment plans will include close monitoring, follow-ups and any changes needed along the way.

Following are treatment options for ADHD:

• Medications
• Behavioral intervention strategies
• Parent training
• School accommodations and interventions

To go to the American Academy of Pediatrics (AAP) policy statement on the treatment of school-aged children with ADHD, visit the Recommendations page.

Behavioral Therapy

Research shows that behavioral therapy is an important part of treatment for children with ADHD. ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and how well they do in their classes. Behavioral therapy is a treatment option that can help reduce these problems for children and should be started as soon as a diagnosis is made. Read about effective therapies here »

Following are examples that might help with your child’s behavioral therapy:

• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
• Get organized. Put schoolbags, clothing, and toys in the same place every day so your child will be less likely to lose them.
• Avoid distractions. Turn off the TV, radio, and computer, especially when your child is doing homework.
• Limit choices. Offer a choice between two things (this outfit, meal, toy, etc., or that one) so that your child isn’t overwhelmed and overstimulated.
• Change your interactions with your child. Instead of long-winded explanations and cajoling, use clear, brief directions to remind your child of responsibilities.
• Use goals and rewards. Use a chart to list goals and track positive behaviors, then reward your child’s efforts. Be sure the goals are realistic—baby steps are important!
• Discipline effectively. Instead of yelling or spanking, use timeouts or removal of privileges as consequences for inappropriate behavior.
• Help your child discover a talent. All kids need to experience success to feel good about themselves. Finding out what your child does well — whether it’s sports, art, or music — can boost social skills and self-esteem.

Behavior Treatment for Preschoolers

The 2011 clinical practice guidelines from the American Academy of Pediatrics recommend that doctors prescribe behavior interventions that are evidence based as the first line of treatment for preschool-aged children (4–5 years of age) with ADHD. Parents or teachers can provide this treatment.

The Agency for Health Care Research and Quality (AHRQ) conducted a review in 2010 of all existing studies on treatment options for preschoolers. The review found enough evidence to recommend parent behavioral interventions as a good treatment option for preschoolers with disruptive behavior in general and as helpful for those with ADHD symptoms.

The AHRQ review found that effective parenting programs help parents develop a positive relationship with their child, teach them about how children develop, and help them manage negative behavior with positive discipline. The review also found four programs for parents of preschoolers that include these key components:

• Triple P (Positive Parenting Program),
• Incredible Years Parenting Program
• Parent-Child Interaction Therapy
• New Forest Parenting Program—Developed specifically for parents of children with ADHD [Abstract] [Authors]

Medications

Medication can help a child with ADHD in their everyday life and may be a valuable part of a child’s treatment. Medication is an option that may help control some of the behavior problems that have led to trouble in the past with family, friends and at school.

Several different types of medications may be used to treat ADHD:

• Stimulants are the best-known and most widely used treatments. Between 70-80 percent of children with ADHD respond positively to these medications.
• Nonstimulants were approved for treating ADHD in 2003. This medication seems to have fewer side effects than stimulants and can last up to 24 hours.

Medications can affect children differently, where one child may respond well to one medication, but not another. When determining the best treatment, the doctor might try different medications and doses, so it is important to work with your child’s doctor to find the medication that works best for your child.