ADHD

ADHD is not just a childhood disorder. Although the symptoms of ADHD begin in childhood, ADHD can continue through
adolescence and adulthood. Even though hyperactivity tends to improve as a child becomes a teen, problems with inattention,
disorganization, and poor impulse control often continue through the teen years and into adulthood.

What causes ADHD?

Researchers at the National Institute of Mental Health (NIMH), National Institutes of Health (NIH), and across the country are
studying the causes of ADHD. Current research suggests ADHD may be caused by interactions between genes and
environmental or non-genetic factors. Like many other illnesses, a number of factors may contribute to ADHD such as:

 Genes
 Cigarette smoking, alcohol use, or drug use during pregnancy
 Exposure to environmental toxins, such as high levels of lead, at a young age
 Low birth weight
 Brain injuries

Warning Signs

People with ADHD show an ongoing pattern of three different types of symptoms:

 Difficulty paying attention (inattention)

 Being overactive (hyperactivity)
 Acting without thinking (impulsivity)

These symptoms get in the way of functioning or development. People who have ADHD have combinations of these symptoms:

 Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
 Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
 Seem to not listen when spoken to directly
 Fail to not follow through on instructions, fail to finish schoolwork, chores, or duties in the workplace, or start tasks but quickly
lose focus and get easily sidetracked
 Have problems organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order,
keeping work organized, managing time, and meeting deadlines
 Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults,
preparing reports, completing forms, or reviewing lengthy papers
 Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses,
and cell phones
 Become easily distracted by unrelated thoughts or stimuli
 Forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Signs of hyperactivity and impulsivity may include:

 Fidgeting and squirming while seated

 Getting up and moving around in situations when staying seated is expected, such as in the classroom or in the office
 Running or dashing around or climbing in situations where it is inappropriate, or, in teens and adults, often feeling restless
 Being unable to play or engage in hobbies quietly
 Being constantly in motion or “on the go,” or acting as if “driven by a motor”
 Talking nonstop
 Blurting out an answer before a question has been completed, finishing other people’s sentences, or speaking without waiting
for a turn in conversation
 Having trouble waiting his or her turn
 Interrupting or intruding on others, for example in conversations, games, or activities
Showing these signs and symptoms does not necessarily mean a person has ADHD. Many other problems, like anxiety,
depression, and certain types of learning disabilities, can have similar symptoms. If you are concerned about whether you or
your child might have ADHD, the first step is to talk with a health care professional to find out if the symptoms fit the diagnosis.
The diagnosis can be made by a mental health professional, like a psychiatrist or clinical psychologist, primary care provider, or
pediatrician.

Treating ADHD

Although there is no cure for ADHD, currently available treatments may help reduce symptoms and improve functioning. ADHD
is commonly treated with medication, education or training, therapy, or a combination of treatments.

Medication

For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn.
The first line of treatment for ADHD is stimulants.

Stimulants: Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it is effective. Many
researchers think that stimulants are effective because the medication increases the brain chemical dopamine, which plays
essential roles in thinking and attention.

Non-Stimulants: These medications take longer to start working than stimulants, but can also improve focus, attention, and
impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant if a person had bothersome side effects from
stimulants, if a stimulant was not effective, or in combination with a stimulant to increase effectiveness. Two examples of non-
stimulant medications include atomoxetine and guanfacine.

Antidepressants: Although antidepressants are not approved by the U.S. Food and Drug Administration (FDA) specifically for
the treatment of ADHD, antidepressants are sometimes used to treat adults with ADHD. Older antidepressants, called tricyclics,
sometimes are used because they, like stimulants, affect the brain chemicals norepinephrine and dopamine.

There are many different types and brands of these medications—all with potential benefits and side effects. Sometimes
several different medications or dosages must be tried before finding the one that works for a particular person. Anyone taking
medications must be monitored closely and carefully by their prescribing doctor.

Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm
than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for
you.

Therapy

There are different kinds of therapy that have been tried for ADHD, but research shows that therapy may not be effective in
treating ADHD symptoms. However, adding therapy to an ADHD treatment plan may help patients and families better cope
with daily challenges.

For Children and Teens: Parents and teachers can help children and teens with ADHD stay organized and follow directions with
tools such as keeping a routine and a schedule, organizing everyday items, using homework and notebook organizers, and
giving praise or rewards when rules are followed.

For Adults: A licensed mental health provider or therapist can help an adult with ADHD learn how to organize his or her life
with tools such as keeping routines and breaking down large tasks into more manageable, smaller tasks.

Education and Training

Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full
potential and to succeed. Mental health professionals can educate the parents of a child with ADHD about the condition and
how it affects a family. They can also help the child and his or her parents develop new skills, attitudes, and ways of relating to
each other. Examples include:
 Parenting skills training teaches parents the skills they need to encourage and reward positive behaviors in their children.
 Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so
that they can respond calmly to their child’s behavior.
 Support groups can help parents and families connect with others who have similar problems and concerns.

Adding behavioral therapy, counseling, and practical support can help people with ADHD and their families to better cope with
everyday problems.

ODD

Symptoms

Sometimes it's difficult to recognize the difference between a strong-willed or emotional child and one with oppositional
defiant disorder. It's normal to exhibit oppositional behavior at certain stages of a child's development.

Signs of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early
teen years. These behaviors cause significant impairment with family, social activities, school and work.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists
criteria for diagnosing ODD. The DSM-5 criteria include emotional and behavioral symptoms that last at least six months.

Angry and irritable mood:

 Often and easily loses temper

 Is frequently touchy and easily annoyed by others

 Is often angry and resentful

Argumentative and defiant behavior:

 Often argues with adults or people in authority

 Often actively defies or refuses to comply with adults' requests or rules

 Often deliberately annoys or upsets people

 Often blames others for his or her mistakes or misbehavior

Vindictiveness:

 Is often spiteful or vindictive

 Has shown spiteful or vindictive behavior at least twice in the past six months

ODD can vary in severity:

 Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.

 Moderate. Some symptoms occur in at least two settings.

 Severe. Some symptoms occur in three or more settings.

Causes
There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and
environmental factors, including:

 Genetics — a child's natural disposition or temperament and possibly neurobiological differences in the way nerves and
the brain function

 Environment — problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or
abuse or neglect

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

 Temperament — a child who has a temperament that includes difficulty regulating emotions, such as being highly
emotionally reactive to situations or having trouble tolerating frustration

 Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental
supervision

 Other family issues — a child who lives with parent or family discord or has a parent with a mental health or substance
use disorder

 Environment — oppositional and defiant behaviors can be strengthened and reinforced through attention from peers
and inconsistent discipline from other authority figures, such as teachers

Complications

Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with
teachers, and at work with supervisors and other authority figures. Children with ODD may struggle to make and keep friends
and relationships.

ODD may lead to problems such as:

 Poor school and work performance

 Antisocial behavior

 Impulse control problems

 Substance use disorder

 Suicide

Many children and teens with ODD also have other mental health disorders, such as:

 Attention-deficit/hyperactivity disorder (ADHD)

 Conduct disorder

 Depression

 Anxiety

 Learning and communication disorders

Treating these other mental health disorders may help improve ODD symptoms. And it may be difficult to treat ODD if these
other disorders are not evaluated and treated appropriately.
Diagnosis

To determine whether your child has oppositional defiant disorder, the mental health professional will likely do a
comprehensive psychological evaluation. Because ODD often occurs along with other behavioral or mental health problems,
symptoms of ODD may be difficult to distinguish from those related to other problems.

Your child's evaluation will likely include an assessment of:

 Overall health

 Frequency and intensity of behaviors

 Emotions and behavior across multiple settings and relationships

 Family situations and interactions

 Strategies that have been hel-pful — or not helpful — in managing problem behaviors

 Presence of other mental health, learning or communication disorders

Treatment

Treatment for oppositional defiant disorder primarily involves family-based interventions, but it may include other types of
psychotherapy and training for your child — as well as for parents. Treatment often lasts several months or longer. It's
important to treat any co-occurring problems, such as a learning disorder, because they can create or worsen ODD symptoms if
left untreated.

Medications alone generally aren't used for ODD unless your child also has another mental health disorder. If your child has
coexisting disorders, such as ADHD, anxiety or depression, medications may help improve these symptoms.

The cornerstones of treatment for ODD usually include:

 Parent training. A mental health professional with experience treating ODD may help you develop parenting skills that
are more consistent, positive and less frustrating for you and your child. In some cases, your child may participate in this
training with you, so everyone in your family develops shared goals for how to handle problems. Involving other
authority figures, such as teachers, in the training may be an important part of treatment.

 Parent-child interaction therapy (PCIT). During PCIT, a therapist coaches parents while they interact with their child. In
one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides parents through
strategies that reinforce their child's positive behavior. As a result, parents learn more-effective parenting techniques,
the quality of the parent-child relationship improves, and problem behaviors decrease.

 Individual and family therapy. Individual therapy for your child may help him or her learn to manage anger and express
feelings in a healthier way. Family therapy may help improve your communication and relationships and help members
of your family learn how to work together.

 Cognitive problem-solving training. This type of therapy is aimed at helping your child identify and change thought
patterns that lead to behavior problems. Collaborative problem-solving — in which you and your child work together to
come up with solutions that work for both of you — can help improve ODD-related problems.

 Social skills training. Your child may also benefit from therapy that will help him or her be more flexible and learn how
to interact more positively and effectively with peers.

As part of parent training, you may learn how to manage your child's behavior by:
  Giving clear instructions and following through with appropriate consequences when needed

 Recognizing and praising your child's good behaviors and positive characteristics to promote desired behaviors

Although some parenting techniques may seem like common sense, learning to use them consistently in the face of opposition
isn't easy, especially if there are other stressors at home. Learning these skills will require routine practice and patience.

Lifestyle and home remedies

At home, you can begin chipping away at problem behaviors of oppositional defiant disorder by practicing these strategies:

 Recognize and praise your child's positive behaviors. Be as specific as possible, such as, "I really liked the way you
helped pick up your toys tonight." Providing rewards for positive behavior also may help, especially with younger
children.

 Model the behavior you want your child to have. Demonstrating appropriate interactions and modeling socially
appropriate behavior can help your child improve social skills.

 Pick your battles and avoid power struggles. Almost everything can turn into a power struggle, if you let it.

 Set limits by giving clear and effective instructions and enforcing consistent reasonable consequences. Discuss setting
these limits during times when you're not confronting each other.

 Set up a routine by developing a consistent daily schedule for your child. Asking your child to help develop that routine
may be beneficial.

 Build in time together by developing a consistent weekly schedule that involves you and your child spending time
together.

 Work together with your partner or others in your household to ensure consistent and appropriate discipline
procedures. Also enlist support from teachers, coaches and other adults who spend time with your child.

 Assign a household chore that's essential and that won't get done unless the child does it. Initially, it's important to set
your child up for success with tasks that are relatively easy to achieve and gradually blend in more important and
challenging expectations. Give clear, easy-to-follow instructions.

 Be prepared for challenges early on. At first, your child probably won't be cooperative or appreciate your changed
response to his or her behavior. Expect behavior to temporarily worsen in the face of new expectations. Remaining
consistent in the face of increasingly challenging behavior is the key to success at this early stage.

Tourette syndrome

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and
vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in
1885 first described the condition in an 86-year-old French noblewoman. The early symptoms of TS are typically noticed first in
childhood, with the average onset between the ages of 3 and 9 years. TS occurs in people from all ethnic groups; males are
affected about three to four times more often than females.

Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited
number of muscle groups. Some of the more common simple tics include eye blinking and other eye movements, facial
grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing,
sniffing, or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups.
Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics
may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics
may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases. Perhaps
the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or
vocal tics including coprolalia (uttering socially inappropriate words such as swearing) or echolalia (repeating the words or
phrases of others). However, coprolalia is only present in a small number (10 to 15 percent) of individuals with TS. Some tics
are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will
describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the
sensation.

Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can
trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger
similar sounds. Tics do not go away during sleep but are often significantly diminished.

TS is a diagnosis that doctors make after verifying that the patient has had both motor and vocal tics for at least 1 year. The
existence of other neurological or psychiatric conditions can also help doctors arrive at a diagnosis. Common tics are not often
misdiagnosed by knowledgeable clinicians. However, atypical symptoms or atypical presentations (for example, onset of
symptoms in adulthood) may require specific specialty expertise for diagnosis. There are no blood, laboratory, or imaging tests
needed for diagnosis. In rare cases, neuroimaging studies, such as magnetic resonance imaging (MRI) or computerized
tomography (CT), electroencephalogram (EEG) studies, or certain blood tests may be used to rule out other conditions that
might be confused with TS when the history or clinical examination is atypical.

Because tic symptoms often do not cause impairment, the majority of people with TS require no medication for tic suppression.
However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics (drugs that
may be used to treat psychotic and non-psychotic disorders) are the most consistently useful medications for tic suppression; a
number are available but some are more effective than others (for example, haloperidol and pimozide).

Although students with TS often function well in the regular classroom, ADHD, learning disabilities, obsessive-compulsive
symptoms, and frequent tics can greatly interfere with academic performance or social adjustment. After a comprehensive
assessment, students should be placed in an educational setting that meets their individual needs. Students may require
tutoring, smaller or special classes, and in some cases special schools.