Attention Deficit: Causes, Signs, Symptoms, Classification, Diagnosis, Treatment and Advice

The name of the disorder has changed as a result of scientific advances and the findings of careful field trials.

Researchers now have strong evidence to support the position that AD is not a specific disorder with different variations.

ADD is officially called Attention Deficit / Hyperactivity Disorder, or AD / HD (American Psychiatric Association, 1994), although most people, and even some professionals, still call it ADD or ADD (the names given in 1980 ) or ADHD.

According to this evidence, ADHD is now divided into three subtypes, according to the main characteristics associated with the disorder: inattention, impulsivity, and hyperactivity.

The three subtypes are:

  • Predominantly combined type.
  • Tipo predominantemente inatento.
  • Predominantly Hyperactive-Impulsive Type.

These subtypes take into account that some children with attention deficit disorder have little or no problem staying still or inhibiting behavior, but may be predominantly inattentive.

As a result, they have great difficulty concentrating on a task or activity.

Others with may pay attention to a task but lose focus because they may be predominantly hyperactive-impulsive and therefore have trouble controlling impulse and activity.

The most common subtype is the combined type. These children will have significant symptoms of all three characteristics.


Attention deficit disorder is a developmental disability based on neurobiology that is estimated to affect between 3-5% of the school-age population. There is not yet a determining factor of its cause.

Scientific evidence suggests that the disorder is genetically transmitted in many cases and is the result of a chemical imbalance or deficiency in certain neurotransmitters, which are chemicals that help the brain regulate behavior.

In addition, a landmark study by the National Institute of Mental Health showed the speed at which the brain uses glucose, its main source of energy, to be influential.

Although the exact cause of ADHD remains unknown, we do know that it is a neurologically based medical problem. Parents and teachers do not originate it.

Still, there are many things both of you can do to help a child manage his related difficulties.

What are the signs of ADHD?

Professionals who diagnose ADHD use the diagnostic criteria established by the American Psychiatric Association (1994) in the Diagnostic and Statistical Manual of Mental Disorders.

The fourth edition of this manual, known as DSM-IV, was published in May 1994. It contains the criteria in the DSM-IV (discussed below) and other essential diagnostic features.

The main characteristics associated with disability are inattention, hyperactivity, and impulsivity.


A child with ADHD is generally described as having a short attention span and being distractible.

In reality, distraction and inattention are not synonymous.

Distraction refers to short attention spans and the ease with which some children can withdraw from homework.

Attention, on the other hand, is a process that has different parts. We focus (we choose something to pay attention to), we select (we select something that needs attention at the moment) and we stick with it (we pay attention for as long as it takes).

We also resist (we avoid things that take our attention away from where it should be), and we change (we move our attention to something else when necessary).

When we refer to someone as distractible, we are saying that a part of that person’s attention process is disrupted.

Children with ADHD may have difficulty with one or all parts of the attention process. Some children may have a hard time concentrating on tasks (particularly tasks that are routine or boring).

Others may have trouble knowing where to start a task. Still others may get lost in directions along the way. A careful observer can observe and see where the attention process breaks down for a particular child.


Symptoms of inattention, as detailed in DSM-IV, are:

  • Doesn’t pay much attention to detail or makes careless mistakes in schoolwork, work, or other activities.
  • Has trouble staying focused on tasks or play activities.
  • Does not seem to listen when spoken to directly.
  • Fails to follow directions and fails to complete schoolwork, housework, or workplace duties (not due to oppositional behavior or misunderstanding of directions).
  • Has difficulty organizing tasks and activities.
  • Avoids, dislikes, or is reluctant to participate in tasks that require sustained mental effort (such as homework or other tasks).
  • Loses things necessary for tasks or activities (for example, toys, schoolwork, pencils, books, or tools).
  • Easily distracted by strange stimuli.
  • Is forgetful in daily activities.


Excessive activity is the most visible sign of ADHD. The hyperactive toddler / preschooler is generally described as “always on the go” or “motor driven.”

With age, activity levels can decrease. In adolescence and adulthood, hyperactivity can appear as restless behavior.

Symptoms of hyperactivity, as detailed in DSM-IV, are:

  • Fidgets with hands or feet or squirms in seat.
  • Leave your seat in the classroom or in other situations where you are expected to remain seated.
  • Runs or climbs excessively in situations where it is inappropriate (in adolescents or adults, it may be limited to subjective feelings of restlessness).
  • Has difficulty playing or participating in leisure activities in silence.
  • Is “on the move” or often acts as if “driven by a motor”
  • Talk excessively.


When people think of impulsivity, they more often think of cognitive impulsivity, which acts without thinking.

The impulsiveness of children with ADHD is slightly different. These children act before they think, because they have a hard time expecting or delaying gratification.

Impulsivity causes these children to speak out of turn, interrupt others, and engage in what seems like risky behavior. The child can cross the street without looking or climb to the top of very tall trees.

Although such behavior is risky, the child is not really a risk taker but rather a child who has great difficulty controlling impulse.

The child is often surprised to find that he has gotten into a dangerous situation and has no idea how to get out of it.

The symptoms of impulsivity, as detailed in the DSM-IV are:

  • Let out answers before the questions have been completed.
  • Has difficulty waiting his turn.
  • Interrupts or intrudes on others (for example, butts in conversations or games).

It is important to note that, in DSM-IV, hyperactivity and impulsivity are no longer considered separate characteristics. According to Barkley (1990), hyperactivity-impulsivity is a pattern that arises from a general difficulty in inhibiting behavior.

In addition to the problems of inattention or hyperactivity-impulsivity, the disorder is often seen with associated characteristics.

Depending on the child’s age and stage of development, parents and teachers may see low tolerance for frustration, temperament, difficulty following rules, disorganization, social rejection, low self-esteem, poor academic performance, and inadequate self-application.


DSM-IV categorically classifies symptoms into three subtypes of the disorder:

  • Combined type: multiple symptoms of inattention, impulsivity, and hyperactivity.
  • Predominantly inattentive type: multiple symptoms of inattention with few, if any, hyperactivity-impulsivity.
  • Predominantly hyperactive-impulsive type: multiple symptoms of hyperactivity-impulsivity with few, if any, of inattention.

Other essential diagnostic features of ADHD include:

  • Symptoms of inattention, hyperactivity, or impulsivity must persist for at least six months and be maladaptive and inconsistent with developmental levels.
  • Some of the symptoms that cause deterioration must be present before 7 years of age.
  • Some symptom disability is present in two or more settings (for example, at school / work and at home).
  • Evidence of clinically significant impairment is present in social, academic, or occupational functioning.
  • Symptoms do not occur exclusively during the course of pervasive developmental disorder, schizophrenia, or other psychotic disorder .
  • They are also not better explained by another mental disorder (eg, mood disorder, anxiety disorder, or personality disorder).

Don’t all children show these signs from time to time?

Every now and then, all children will be inattentive, impulsive, and excessively the rule, not the exception.

When a child exhibits the behaviors listed above as symptomatic of ADHD, even if they do so consistently, do not conclude that the child has the disorder.

Until a proper evaluation is completed, you can only assume that the child might have ADHD. Rather, people have been known to read lists of symptoms and finding one or two exceptions to rule out the possibility of the disorder being present.

ADHD is a disability that, without proper identification and treatment, can have long-term complications. Parents and teachers are cautioned not to make the diagnosis themselves.


Unfortunately, there is no simple test like a blood test or urinalysis to determine if a child has this disorder.

Diagnosing ADHD is complicated and much like putting together a puzzle, an accurate diagnosis requires an evaluation by a well-trained professional.

This can generally be a developmental pediatrician, child psychologist, child psychiatrist, or pediatric neurologist, who knows a lot about ADHD and all other disorders that can have symptoms similar to those encountered.

Until the professional has collected and evaluated all the necessary information, he or she should follow the same general rule as the parent or teacher who sees the behavior and suspect that the child has the disorder, that is, assume that the child could have ADHD .

The diagnosis is made on the basis of behavioral symptoms observable in multiple settings. This means that the person conducting the assessment must use multiple sources to gather the necessary information.

A diagnostic evaluation includes the following elements:

  • A complete medical and family history.
  • A physical exam.
  • Interviews with the child’s parents, child, and teacher (s).
  • Behavior rating scales completed by parents and teacher (s)
  • Observation of the child : a variety of psychological tests to measure IQ and social and emotional adjustment, as well as to indicate the presence of specific learning disabilities.

It is important to realize that, almost characteristically, children with ADHD often behave well in new situations, particularly in those settings that are one-on-one.

Therefore, a well-trained diagnostician knows not to make a determination based solely on how the child behaves during their time together.

Sophisticated medical tests such as EEG (to measure the electrical activity of the brain) or MRI (an X-ray of the anatomy of the brain) are not part of the routine evaluation.

Such tests are usually given only when the diagnostician suspects another problem, and such cases are rare.

Similarly, positron emission tomography (PET Scan) has recently been used for research purposes, but is not part of the diagnostic evaluation.

After completing an evaluation, the diagnostician makes one of three determinations:

  • The child has ADHD.
  • The child does not have ADHD but his difficulties are the result of another disorder or other factors.
  • The child has ADHD and another disorder (called a coexisting condition).

To make the first determination that the child has ADHD, the professional considers their findings in relation to the criteria established in the Diagnostic and Statistical Manual of Mental Disorders (4th edition), DSM-IV, of the American Psychiatric Association ( 1994).

A very important criterion for diagnosis is that the child’s symptoms are present before 7 years of age. They must also be inappropriate for the child’s age and cause clinically significant impairment in social and academic functioning.

To make the second determination, that the child’s difficulties are the result of another disorder or other factors, the professional considers the exclusion criteria found in the DSM-IV and their knowledge of disorders with similar symptoms.

According to DSM-IV, attention deficit hyperactivity disorder is not diagnosed if the symptoms are better explained by another mental disorder, for example:

  • Mood disorder
  • Anxiety disorder.
  • Dissociative disorder
  • Personality Disorder – Personality change due to a general medical condition or substance-related disorder.

In all these disorders, symptoms of inattention usually appear after the age of 7.

The childhood school adjustment history is generally not characterized by disruptive behaviors or teacher complaints related to inattentive, hyperactive, or impulsive behavior.

Additionally, psychosocial stressors such as parental divorce, child abuse, the death of a loved one, environmental disruption (such as changing residence or school), or disasters can cause temporary symptoms of inattention and hyperactivity.

Under these circumstances, symptoms usually appear suddenly and therefore would not have a long-term history.

Of course, a child can have ADHD and also experience psychosocial stress, so such events do not automatically exclude the existence of ADHD.

To make the third determination that the child has ADHD and a coexisting condition: the counselor must first be aware that ADHD can and often does coexist with other difficulties.

These are particularly learning disabilities such as: oppositional defiant disorder and conduct disorder. All factors must be considered to ensure that the child’s difficulties are comprehensively assessed and managed.

Clearly, diagnosis is not as simple as reading a list of symptoms and saying, “This child has ADHD.” This informational document explores the topic of diagnosis in some depth, because no one wants children to be misdiagnosed.

As parents, the more we know, the more we can help our children be successful.

We probably don’t need to know how to use the DSM-IV. We probably need to know that the person evaluating our child is using the specified criteria to determine ADHD and all components of a comprehensive evaluation.


Treatment for attention deficit hyperactivity disorder ADHD can help relieve symptoms and make the condition much less of a problem in everyday life.

ADHD can be treated with medication or therapy, but it is often best to combine both.

Treatment is usually organized by a specialist, such as a pediatrician or psychiatrist, although your GP can manage the condition.


There are 5 types of medications licensed for the treatment of ADHD:

  • Methylphenidate.
  • Dexanfetamina.
  • Lisdexanfetamina.
  • Atomoxetine.
  • Guanfacina.

These medications are not a permanent cure for ADHD, but they can help someone with the condition to focus better, be less impulsive, feel calmer, and learn and practice new skills.

Some medications need to be taken every day, but some can only be taken on school days. Sometimes treatment breaks are recommended to assess whether the drug is still needed.

If you were not diagnosed with ADHD until adulthood, your GP and specialist can discuss which medications and therapies are right for you.

If you or your child is prescribed one of these drugs, they will probably be given small doses at first, which can then be gradually increased.

You or your child will need to see your GP for regular check-ups to make sure the treatment is working effectively and for signs of side effects or problems.

It is important to inform your GP about side effects and talk to them if you feel you need to stop or change treatment.

Your specialist will discuss how long to take your treatment, but in many cases, treatment continues as long as it is helping you.


Methylphenidate is the most commonly used medication for ADHD. It belongs to a group of medicines called stimulants, which work by increasing activity in the brain.

Particularly in areas that play a role in controlling attention and behavior.

Methylphenidate can be offered to adults, adolescents, and children over the age of 5 with ADHD.

The medicine can be taken as immediate-release tablets (small doses taken 2-3 times a day) or as modified-release tablets (taken once a day in the morning and the dose is released throughout the day).

Common side effects of methylphenidate include:

  • A small increase in blood pressure and heart rate.
  • Loss of appetite, which can lead to weight loss or poor weight gain.
  • Trouble sleeping
  • Headaches.
  • Stomach aches.
  • Humor changes.

It is a drug similar to dexamphetamine and works in the same way.

It can be offered to adolescents and children over 5 years of age with ADHD if at least 6 weeks of treatment with methylphenidate have not helped. Adults may be offered lisdexamfetamine as the drug of first choice instead of methylphenidate.

Lisdexamfetamine comes as a capsule, taken once a day. Common side effects of this include:

Decreased appetite, which can lead to weight loss.

  • Aggression.
  • Drowsiness.
  • Dizziness.
  • Headaches.
  • Diarrhea.
  • Nausea and vomiting

Dexamphetamine is similar to lisdexamphetamine and works in the same way. It can be offered to adults, adolescents, and children over the age of 5 with ADHD.

Dexamphetamine is usually taken as a tablet once or twice a day, although an oral solution is also available.

Common side effects of dexamphetamine include:

  • Decreased appetite.
  • Humor changes.
  • Agitation and aggression.
  • Dizziness.
  • Headaches.
  • Diarrhea.
  • Nausea and vomiting

Atomoxetine works differently from other ADHD medications.

It is a selective norepinephrine reuptake inhibitor (SNRI), which means that it increases the amount of a chemical in the brain called norepinephrine.

This chemical transmits messages between brain cells, and increasing it can aid concentration and help control impulses.

Atomoxetine can be offered to adults, adolescents, and children over 5 years of age if methylphenidate or lisdexamfetamine cannot be used. It is also licensed for use in adults if ADHD symptoms are confirmed.

Atomoxetine comes in capsule form, usually taken once or twice a day.

Common side effects of atomoxetine include:

  • Small increase in blood pressure and heart rate.
  • Nausea and vomiting
  • Stomach aches.
  • Trouble sleeping
  • Dizziness.
  • Headaches.
  • Irritability.

Atomoxetine has also been linked to some more serious side effects that are important to be aware of, including suicidal thoughts and liver damage.

If you or your child begin to feel depressed or suicidal while taking this medicine, talk to your doctor.


Guanfacine works on part of the brain to improve attention and also lowers blood pressure.

It can be offered to adolescents and children older than 5 years if it is not possible to use methylphenidate or lisdexamfetamine. Guanfacine should not be offered to adults with ADHD.

Guanfacine is usually taken as a tablet once a day, in the morning or in the evening.

Common side effects include:

  • Tiredness or fatigue
  • Headache.
  • Abdominal pain.
  • Dry mouth.


When taking medications, different therapies can be helpful in treating ADHD in children, adolescents, and adults.

The therapy is also effective in treating additional problems, such as conduct or anxiety disorders, that can occur with ADHD. Some of the therapies that can be used are detailed below.


Pedagogical education means that you or your child will be encouraged to talk about ADHD and its effects. It can help children, teens, and adults get diagnosed with ADHD, and it can help you cope with and live with the condition.

Behavior therapy

Behavior therapy provides support to caregivers of children with ADD and can involve both teachers and parents.

Behavioral therapy generally involves behavior management, which uses a reward system to encourage your child to try to control his ADHD.

If your child has ADHD, you can identify the types of behavior you want to encourage, such as sitting at the table to eat. Your child is given a kind of small reward for good behavior and a privilege is taken away for bad behavior.

For teachers, behavior management involves learning to plan and structure activities, and praising and encouraging children even for very little progress.

Training and education programs for parents.

If your child has ADHD, specially designed parenting education and training programs can help you learn specific ways to talk with your child and play and work with them to improve their attention and behavior.

Parenting training may also be offered to your child who is formally diagnosed with ADHD. These programs are generally organized in groups of around 10 to 12 parents.

A program generally consists of 10 to 16 meetings, lasting up to 2 hours each.

Offering a parenting training and education program doesn’t mean you’ve been a bad parent – it aims to teach parents and caregivers about behavior management, while increasing confidence in your ability to help your child and improve your relationship. .

Social skills training

Social skills training involves your child participating in role-play situations and aims to teach them how to behave in social situations by learning how their behavior affects others.

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy is therapy that can help you manage your problems by changing the way you think and behave.

A therapist would try to change the way your child feels about a situation, which in turn could change his behavior.

It can be done with a therapist individually or in a group.

Other possible treatments

There are other ways to treat ADHD. Such as cutting certain foods and taking supplements.

However, there is no strong evidence for this work, and it should not be attempted without medical advice.


People with ADHD should eat a healthy and balanced diet. Do not cut food before seeking medical advice.

Some people may notice a link between food types and worsening ADHD symptoms.

For example, sugar, dyes, food additives, and caffeine are often blamed for aggravating hyperactivity, some people believe they have an intolerance to wheat or dairy products, which can increase your symptoms.

If this is the case, keep a journal of what you eat and drink, and what behavior you follow. Discuss this with your GP, who may refer you to a dietitian (a health professional who specializes in nutrition).


Some studies have suggested that omega-3 and omega-6 fatty acid supplements may be beneficial for people with ADHD, although the evidence for this is very limited.

It is advisable to speak with your GP before using any supplements, as some may react unpredictably with medications or make them less effective. You should also remember that some supplements should not be taken long term as they can be dangerous.

Tips for parents

If you are the parent of a child with ADHD make sure your GP or specialist helps you understand the difference between ADHD and any other problems your child may have.

For more information about your child’s ADHD, like school or daycare, find out the side effects of any medicine your child takes.

In addition to what you can learn from people in local support groups, they can prevent you from feeling isolated and unable to cope with this disorder.