Many childhood mental illnesses escape notice, but children with attention deficit hyperactivity disorder (ADHD) are often the subject of great concern on the part of parents and teachers. Children with ADHD-the most common of the psychiatric disorders that appear in childhood-can't stay focused on a task, act without thinking, can't sit still, and rarely finish anything. If untreated, the disorder can have long-term effects on a child's ability to make friends or do well at school or work. Over time, children with ADHD may develop depression, lack of self-esteem, and other emotional problems.

• Experts estimate that ADHD affects 3 to 5 percent of school-age children.
• ADHD affects two to three times as many boys as girls.
• Children with untreated ADHD have higher than normal rates of injury.
• ADHD frequently co-occurs with other problems, such as depression and anxiety disorders, conduct disorder, drug abuse, or antisocial behavior.

Research has shown that certain medications, stimulants in most cases, and behavioral therapies that help children sit still, pay attention, and focus on tasks are the most beneficial treatments for children with ADHD.

Problems Faced by Families

ADHD can be reliably diagnosed when appropriate guidelines are used. Ideally, a health care practitioner making a diagnosis should include input from parents and teachers. But some health practitioners make a diagnosis without all this information and tend to either overdiagnose the disorder or underdiagnose it. Despite data showing that stimulant medication is safe, there are widespread misunderstandings about the safety and use of these drugs, and some health care practitioners are reluctant to prescribe them. Like all drugs, the medications used to treat ADHD do have side effects and need to be closely monitored.

Given the controversy in the health care community, parents need to think carefully about treatment choices when their child receives a diagnosis of ADHD. And when they pursue treatment for their children, families face high out-of-pocket expenses because treatment for ADHD and other mental illnesses is often not covered by insurance policies. In schools, treatment plans are often poorly integrated. In addition, there are few special education funds directed specifically for ADHD. All this leads to children who do not receive proper and adequate treatment. To overcome these barriers, parents may want to look for school-based programs that have a team approach involving parents, teachers, school psychologists, other mental health specialists, and physicians.

Recent Research Findings

Magnetic resonance imaging research has shown that the brains of children with ADHD differ from those of children without the disorder. In addition, there appears to be a link between a person's ability to pay continued attention and the use of glucose-the body's major fuel-in the brain. In people with ADHD, the brain areas that control attention use less glucose and appear to be less active, suggesting that a lower level of activity in some parts of the brain may cause inattention.

Research shows that ADHD tends to run in families, so there are likely to be genetic influences. Children who have ADHD usually have at least one close relative who also has ADHD. And at least one-third of all fathers who had ADHD in their youth have children with ADHD. Even more convincing of a possible genetic link is that when one twin of an identical twin pair has the disorder, the other is likely to have it too.

Data from 1995 show that physicians treating children and adolescents wrote six million prescriptions for stimulants-methylphenidate (Ritalin®, dextroamphetamine (Dexedrine®), and pemoline (Cylert®). Of all the drugs used to treat psychiatric disorders in children, stimulant medications are the most well-studied. A 1998 Consensus Development Conference on ADHD sponsored by the National Institutes of Health and a recent, comprehensive scientific report confirmed many earlier studies showing that short-term use of stimulants is safe and effective for children with ADHD. Evidence is mounting that suggests stimulants are more effective than behavioral therapies in controlling the core symptoms of ADHD-inattention, hyperactivity/impulsiveness, and aggression. But the addition of behavioral treatments seems to result in improved functioning, in terms of better social skills and higher academic achievement. More studies are needed to assess the combination of medication and behavioral therapies and to examine the long-term use of stimulant medication.

NIH Publication No. 99-4589