ADHD in Children: Symptoms, Causes, and Treatment

Introduction

Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most common neurobehavioral childhood disorders, with approximately 5% of school-age children affected by the condition (Czamara, Tiesler, Kohlbock et al., 2013). According to the DSM-5 (2013), ADHD is characterized by inattention, hyperactivity, and impulsivity, all of which interfere with the child's ability to engage in quality "social, academic, or occupational functioning" (p. 2) for an extended period of time—at least six months or more. This paper discusses the symptoms that a child with ADHD may exhibit, age of onset and gender differences, etiology, course, prognosis, current treatment options, and a differential diagnosis for the disorder.

Symptom Picture and Cultural Variables

Prevalence rates worldwide for ADHD stand at 5.29% (Smith, 2017). This figure is broadly consistent with rates in the United States, where approximately one out of every twenty children is affected by ADHD (Faraone, Sergeant, Gillberg, & Biederman, 2003).

A child who has ADHD typically experiences a range of emotions and impulses that often prevent the child from limiting his or her train of thought to a single idea or subject. In many cases, a child with ADHD will perceive numerous corollaries to a single idea and feel compelled to explore them. At the same time, the child may be aware of the underlying problem of pursuing so many tangential sequences, but—feeling frustrated by his or her inability to prevent the mind from exploring these tangents—the child can easily become upset, distracted, and annoyed. These feelings may be directed inward or outward.

Simultaneously, the child may want to focus on a single activity while also feeling drawn to several others, producing tension and conflict within the body, mind, and will. The challenge for the child is to understand these conflicting impulses and develop the ability to control them, which can at times be beyond the child's grasp (Caye, Swanson, Thapar et al., 2016).

Children with ADHD also face the challenge of developing relationships with peers, a task that can be quite difficult (McQuade & Hoza, 2015). Misbehavior often stems from the child's inability to control impulses, which can upset other children and cause the child with ADHD to feel isolated, disliked, and even despised. It is difficult for these children to understand why they feel marginalized, and their responses to those feelings can increase the social distance between them and their peers—especially if those feelings are expressed confrontationally. This dynamic can easily carry over into school performance, where the child with ADHD may perform poorly.

Regarding cultural variation, research by Davis, Cheung, Takahashi, Shinoda, and Lindstrom (2011) indicates there is essentially no meaningful difference in ADHD prevalence across cultures. Whether among children in the UK, Japan, Ukraine, or Central America, the findings demonstrate that ADHD is a universal disorder affecting children of all cultures and ethnicities with comparable frequency. According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD, 2018), prevalence among children ages 2–17 in the United States breaks down as follows:

• 8.4 percent White
• 10.7 percent Black
• 6.6 percent Other
• 6.0 percent Hispanic/Latino
• 9.1 percent Non-Hispanic/Latino

There is wide disparity among U.S. states, however. Nevada has the lowest rate of ADHD prevalence at 4.2%, while Kentucky has the highest rate at 14.8% (CHADD, 2018).

Age of Onset and Gender Features

The average age at which symptoms first appear ranges from 2 to 17 years, with most children diagnosed between ages 6 and 11 and most children demonstrating signs of the disorder between ages 11 and 14. Symptoms tend to diminish as children grow older if the disorder is appropriately treated (CHADD, 2018). The majority of children diagnosed with ADHD are boys: 13.3% of boys have ADHD compared to only 5.6% of girls (CHADD, 2018). Onset is typically gradual and can range in severity from mild to moderate to severe. Approximately 5.1 million children in the United States are currently diagnosed with ADHD, and the average age at the time of diagnosis is 6 years. Mild ADHD is most commonly diagnosed at age 7, Moderate ADHD at age 6, and Severe ADHD most commonly at age 4.5 (CHADD, 2018).

Etiology

Voeller (2004) notes that ADHD can be both inherited and acquired and that it is not always possible for physicians to distinguish between the two forms. The disorder is considered to be "a disorder of neurotransmitter function, with particular focus on the neurotransmitters dopamine and norepinephrine" (Voeller, 2004, p. 799). Research indicates that dopamine plays a major role in regulating the impulses to which the child reacts and has a significant impact on learning, behavior, and motivation. It also factors into memory-related tasks and can modulate neuronal activity related to motor processes. As Voeller (2004) states, "dopamine plays an important role in the function of the prefrontal-subcortical system" (p. 800).

Norepinephrine is also a major factor in the child's capacity to maintain alertness and sustain attention during tasks. Environmental factors can additionally contribute to the onset of the disorder: children who grow up in chaotic environments or unstable family situations tend to show signs of ADHD more frequently than children raised in stable environments. Voeller (2004) states that "the risk of ADHD is proportional to the number of adverse factors (e.g., poverty, maternal psychopathology, paternal criminality) that are present" (p. 804).

References

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CHADD. (2018). ADHD. Retrieved from http://www.chadd.org/understanding-adhd/about-adhd/data-and-statistics/general-prevalence.aspx

Chambers, A., Taylor, J., & Potenza, M. (2014). Developmental neurocircuitry of motivation in adolescence: A critical period of addiction vulnerability. The American Journal of Psychiatry, 160(6), 1041–1052.

Czamara, D., Tiesler, C., Kohlbock, G., et al. (2013). Children with ADHD symptoms have a higher risk for reading, spelling, and math difficulties in the GINIplus and LISAplus cohort studies. PLOS One, 8(5), 1–7.

Davis, J. M., Cheung, S. F., Takahashi, T., Shinoda, H., & Lindstrom, W. A. (2011). Cross-national invariance of Attention-Deficit/Hyperactivity Disorder factors in Japanese and US university students. Research in Developmental Disabilities, 32(6), 2972–2980.

DSM-5. (2013). ADHD. Retrieved from https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ADHD.pdf

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Kumperscak, H. (2013). ADHD through developmental stages. Retrieved from https://www.intechopen.com/books/attention-deficit-hyperactivity-disorder-in-children-and-adolescents/adhd-through-different-developmental-stages

McQuade, J. D., & Hoza, B. (2015). Peer relationships of children with ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 210–222). New York: Guilford Press.

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