December 19, 2014
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ADHD: basic information

Attention-deficit hyperactivity disorder (ADHD) may present different problems at each stage of life, depending on the demands a person faces. Infants who later go on to have difficulties with ADHD may be described as colicky, insistent, or active. The "terrible twos" are often more difficult and persist for longer. Toddlers require constant supervision, and may be accident prone. Preschool children with ADHD often wander, have trouble sharing, and cannot sit for quiet activities such as "circle time." Young children with ADHD may have other developmental problems such as bedwetting or problems with writing.

The transition to Grade 1 is marked by the demand to sit still and work for extended periods of time, which can be frustrating and exhausting for a child who needs to be "on the go." Parents of children with ADHD-combined usually come to understand that something is wrong, and that their child needs medical attention, when the child is about 9 years old. By Grade 3, children with ADHD also come to realize that they are "different." They feel rejected by other children, experience conflict with their parents, and have trouble doing their work at school. They have trouble with chores, homework, getting ready for school, staying on task, and settling to bed at night. Problems with discipline may lead to conflict in the parents' marriage. Children with ADHD may have serious problems getting along with sisters and brothers. Many children with ADHD socialize better with younger children, with an older child, with animals, or one-to-one with an adult or grandparent. Finding situations that are positive experiences for the child helps them to feel better about themselves.

In the past, parents were told that their children would grow out of ADHD. However, when studies were done that followed children with ADHD into adolescence, it was found that the early teens often presented as much, if not more, difficulty. In high school, teenagers are not supervised as closely as they are in elementary school, while at the same time teachers expect students to be more organized, disciplined, and self-motivated. Teenagers with ADHD may be rejected by the "good kids" and accepted by troubled teens who have drug, alcohol, or conduct problems. A teenager with ADHD is bigger than he was when he was younger, but may be just as impulsive and aggressive. The change is that a large 14-year-old's severe tantrum or hitting episode is likely to be perceived as a serious threat that will be followed by legal charges or possible expulsion from school. The teen years include risks of substance abuse, driving accidents, problems with the law, inappropriate social and sexual behaviours, and pregnancy. Even when hyperactive behaviours diminish, the impulsive behaviours may become more risky, and the attention deficit more disabling.

There are many occupations (e.g., the stock market, self-employed business ventures, salesman, contractor) that are ADHD friendly. Hyperactivity seems to diminish for many individuals in adulthood, although difficulties with an inner restlessness, being too talkative, or being a workaholic may persist. Many adults complain of difficulties with attention, organization, and money management. Mothers often have difficulty with housework and parenting. These difficulties may still impact significantly on simple activities of daily living such as cooking, cleaning, self-care, close relationships, and occupational success. Long-term follow-up studies have indicated that one third of children will have some symptoms and some impairment as adults, and another third will meet the full diagnostic criteria for ADHD. For reasons that are not clearly understood, in childhood more boys than girls go to a doctor for help, while the ratio is equal in adults.

 
Margaret Weiss, MD

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