Attention-Deficit Hyperactivity Disorder (ADHD) is a common disorder in children. This handout has been developed to educate parents regarding the causes, symptoms, and issues associated with Attention-Deficit Hyperactivity Disorder (ADHD). Designed as an overview, years of experience with ADHD children and adults has prompted the identification of several patterns of behavior described in this handout. Information in the handout has been obtained from several sources - professional experience, books, parent/student interviews, and internet websites. This handout is not a substitute for professional evaluation or assessment of ADHD in children and is placed on the internet as a resource for those interested in Attention-Deficit Hyperactivity Disorder (ADHD).

Causes of Attention-Deficit Hyperactivity Disorder (ADHD)

Attention-Deficit Hyperactivity Disorder (ADHD) has been clinically researched for over thirty-five years. Various labels have been utilized to reflect two basic themes - the predominant symptom of hyperactivity and the clinical assumption that ADHD is related to a neurological dysfunction. Thus, early labels such as "Hyperkinetic Reaction in Childhood", "Minimal Brain Damage", and "Minimal Brain Dysfunction" were used to describe the condition. As research accumulated and better neurological assessment equipment surfaced, professionals began to understand the complex nature of Attention-Deficit Hyperactivity Disorder (ADHD), its' symptoms, and how it can be treated.

Attention-Deficit Hyperactivity Disorder (ADHD) is caused by neurological rather than parental, social, or emotional causes. The cause of Attention-Deficit Hyperactivity Disorder (ADHD) has been linked with the brain's chemical system, not it's structure. Thus, Attention-Deficit Hyperactivity Disorder (ADHD) is a problem with brain chemistry - not brain damage or injury.

The brain uses multiple chemical substances for operation, regulation, and communication. These chemicals, called "neurotransmitters", serve various functions in the brain. Three neurotransmitters have been linked to behavioral and emotional conditions: Dopamine, Serotonin, and Norepinephrine. If we imagine using a "dipstick", like the dipstick used to check oil/transmission fluid levels in our automobile, we might be able to check the neurotransmitter levels in our brain, finding which neurotransmitters are low, within the normal range, or high. Low levels of Serotonin, for example, are linked with clinical depression and for that reason, modern antidepressant medication increases the availability of the Serotonin neurotransmitter in the brain.

Attention-Deficit Hyperactivity Disorder (ADHD) appears related to two neurotransmitters - Dopamine and Norepinephrine. Neurotransmitters are used by the brain to stimulate or repress stimulation in brain cells. To pay proper attention, the brain must be adequately stimulated. To have proper control of our impulses, areas of the brain must be adequately controlled, repressed, or slowed down. In ADHD children, both systems of stimulation and repression are not working correctly. Some studies suggest that ADHD Children/Adults may have only ten to twenty-five percent of these two neurotransmitters found in the normal brain.

Inattention and distractibility appear to be related to low levels of Norepinephrine. ADHD Children/Adults can't judge which things in their environment are important and which should be ignored. ADHD Children/Adults often feel the flight path of a fly in the room is as important as the teacher's algebra lesson. To the ADHD Child/Adult, everything on the desk is equally interesting and worthy of attention. Low levels of Norepinephrine also make it very difficult for ADHD Children/Adults to sustain their focus on a task, plan ahead, and understand such concepts as sequence and time.

The impulse and behavior problems found in Attention-Deficit Hyperactivity Disorder (ADHD) appear related to low levels of Dopamine in the brain. When dopamine levels are normal, we can repress the urge to do or say something in public, grab something interesting on a desk, blurt out our opinion, or touch/poke someone who has just walked within our physical range. Low levels of dopamine in the brain makes control of impulsive behavior almost impossible in the ADHD Child/Adult.

In treatment, medications effective with ADHD Children/Adults are those which alter levels of Dopamine and Norepinephrine. Stimulate medications (Ritalin) are known to increase the production of these two neurotransmitters - boosting their levels into the normal range and producing increased attention and decreased impulsivity. Other medications with similar actions, such as antidepressant medications, can also be of use in the treatment of ADHD Children/Adults.

The many symptoms and behaviors found in ADHD Children/Adults are linked to the various levels of these two neurotransmitters. ADHD is diagnosed in children and adults by recognizing the patterns and symptoms found in the condition. This paper will explore the symptoms associated with Attention-Deficit Hyperactivity Disorder (ADHD).

Diagnosis of Attention-Deficit Hyperactivity Disorder

The essential features of Attention-Deficit Hyperactivity Disorder (ADHD), as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994), is the presence of developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. Individuals with the disorder generally display some disturbance in each of these areas, but to varying degrees.

The following is a list of symptoms commonly associated with Attention-Deficit Hyperactivity Disorder (ADHD) based on the 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV):

These symptoms are related to inattention...

1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities. ADHD Children/Adults children are famous for skipped math problems, milk cartons on the kitchen table, etc.
2. Often has difficulty sustaining attention in tasks or play activities. A two-minute timed task is often interrupted by glancing about the room.
3. Often does not seem to listen when spoken to directly. As described, ADHD Children/Adults are often considered to have hearing problems or difficulties in auditory processing due to their inability to hear or respond to comments.
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties. ADHD Children/Adults quit games half-way through, half-clean their room, or wander off in the middle of projects. Homework is often partially finished or even if finished, the ADHD student forgets to turn it in.
5. Often has difficulty organizing tasks and activities. Many tasks/activities require planning and organization. An adult might gather four tools for a project in one trip. The ADHD individual must retrieve one tool at a time, failing to see the big picture and the equipment that might be needed.
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained effort. Homework and schoolwork are often an ordeal for the ADHD Child and his/her parents. What should normally take 30 minutes requires three hours and after the ordeal, both student and parent are exhausted and traumatized.
7. Often loses things necessary for tasks or activities. ADHD Children misplace pencils, notebooks, and other needed equipment. They forget lunch money or inform you 20 minutes before bedtime that they need a large posterboard for a project the next day.
8. If often easily distracted by extraneous stimuli. Noises, conversation, flying birds, movements by others - almost anything can draw the attention of ADHD Children from their task at hand.
9. If often forgetful in daily activities.

These symptoms are related to hyperactivity...

1. Often fidgets with hands or feet or squirms in seat. ADHD Children look much like a running motor with a rough idle. If we imagine a video recording of the ADHD Children, their body is almost constantly in movement, importantly, purposeless movement.
2. Often leaves seat in classroom or in other situations in which remaining seated is expected. Depending upon the severity of the hyperactivity, ADHD Children have difficulty remaining seated in school, church, family gatherings, etc. In school, ADHD Children are known to "pop up" from their seat, as though gravity was suddenly canceled in their area.
3. Often runs about or climbs excessively in situations in which it is inappropriate. Younger ADHD children are climbers, runners, bouncers, tumblers, and jumpers. As the ADHD Child matures, he/she may report an internal sensation of a "running motor" or restlessness. Hyperactivity in ADHD adolescents can also take the form of finger drumming, restless legs, excessive humming/singing/whistling, and even object-drumming. ADHD teens often turn kitchen canisters and tables into drum sets.
4. Often has difficulty playing or engaging in leisure activities quietly. As the excitement builds in an ADHD Child, so increases the voice and physical activity. When playing video games, ADHD Children often shout, yell, and physically act their participation.
5. Often "On the go" or acts as if "driven by a motor".
6. Often talks excessively. ADHD Children and Adults talk and question excessively. Questions are often totally unrelated to the task at hand. ADHD in adults often produces the "fast talker" we find in certain occupations.

These symptoms are related to impulsivity...

1. Often blurts out answers before questions have been completed. Labeled "disruptive" in the classroom setting, ADHD Children fail to raise their hand or await proper acknowledgment before speaking in group situations.
2. Often has difficulty awaiting turn. If we study the actual location where ADHD Children have difficulty, it's often when they are waiting - the cafeteria line, riding on the bus, in line before recess, etc. During such times, ADHD Children can't control their urge to physically touch/poke or irritate others.
3. Often interrupts or intrudes on others. ADHD Children butt into conversations, interrupt adults, interrupt games, and demand responses to questions when the parent/teacher is already engaged. ADHD Children have few "social graces" for this reason.