Which of the following is most likely the cause of attention deficit hyperactivity disorder ADHD )?

What Is ADHD?

ADHD stands for attention deficit hyperactivity disorder. It’s a brain disorder that affects how you pay attention, sit still, and control your behavior. It happens in children and teens and can continue into adulthood.

ADHD is the most commonly diagnosed mental disorder in children. Boys are more likely to have it than girls. It’s usually spotted during the early school years, when a child begins to have problems paying attention.

ADHD can't be prevented or cured. But spotting it early, plus having a good treatment and education plan, can help a child or adult with ADHD manage their symptoms.

ADHD Types

Symptoms are grouped into three types:

Inattentive. A child with ADHD:

• Is easily distracted
• Doesn't follow directions or finish tasks
• Doesn't seem to be listening
• Doesn't pay attention and makes careless mistakes
• Forgets about daily activities
• Has problems organizing daily tasks
• Doesn’t like to do things that require sitting still
• Often loses things
• Tends to daydream

Hyperactive-impulsive. A child with ADHD:

• Often squirms, fidgets, or bounces when sitting
• Doesn't stay seated
• Has trouble playing quietly
• Is always moving, such as running or climbing on things. (In teens and adults, this is more often described as restlessness.)
• Talks excessively
• Is always “on the go,” as if “driven by a motor”
• Has trouble waiting for their turn
• Blurts out answers
• Interrupts others

Combined. This involves signs of both other types.

ADHD Symptoms in Adults

Symptoms of ADHD may change as a person gets older. They include:

• Often being late or forgetting things
• Anxiety
• Low self-esteem
• Problems at work
• Trouble controlling anger
• Impulsiveness
• Substance misuse or addiction
• Trouble staying organized
• Procrastination
• Easily frustrated
• Often bored
• Trouble concentrating when reading
• Mood swings
• Depression
• Relationship problems

ADHD vs. ADD

Attention deficit disorder (ADD) is the old name for ADHD. It was officially changed in the 1990s. Some people still use both names to talk about this one condition.

ADHD Causes

Experts aren’t sure what causes ADHD. Several things may lead to it, including:

• Genes. ADHD tends to run in families.
• Brain chemicals. These may be out of balance in people with ADHD.
• Brain changes. Areas of the brain that control attention are less active in children with ADHD.

Sugar doesn’t cause ADHD. ADHD also isn’t caused by too much TV, a stressful home life, poor schools, or food allergies.

ADHD Risk Factors 

Studies have found that a number of risk factors may play a role in the development of ADHD. Some of them affect a baby’s brain development during pregnancy: 

• Poor nutrition
• Infections
• Smoking
• Drinking 
• Substance abuse 

Other things may affect a child's brain development after birth. Some of the things researchers have looked at include: 

• Being born prematurely
• Toxins, such as lead
• A brain injury or a brain disorder. Damage to the front of the brain, called the frontal lobe, can cause problems controlling impulses and emotions.
• “Western” diet. One study found that children who ate a diet high in added sugar, fats, and sodium and low in fiber and omega-3 fatty acids had a greater chance of ADHD. 
• Nutritional deficiencies
• Food additives. There may be a link between food coloring additives and preservatives and ADHD, but this may only be for children who are already at a high level of risk for the condition.
• Family income. Children from low-income families or families that have a drop in income have a greater chance of having ADHD. 

ADHD Diagnosis and Testing

It can be hard to diagnose ADHD, especially in children. No one test will spot it. Doctors diagnose ADHD in children and teens after discussing symptoms at length with the child, parents, and teachers and then observing the child's behaviors.

Doctors use the American Psychiatric Association’s guidelines, which are based on how many symptoms a person has and how long they’ve had them. They’ll also rule out other things that may be causing the symptoms, such as health conditions or problems in daily life.

To confirm a diagnosis of ADHD or learning differences, a child may take a series of tests to check their neurological and psychological status. The tests should be given by a pediatrician or mental health professional with experience in diagnosing and treating ADHD. Your primary care doctor might refer you to a specialist such as a psychiatrist or psychologist. The tests may include:

• A medical and social history of both the child and the family.
• A physical exam and neurological assessment that includes screenings of vision, hearing, and verbal and motor skills. More tests may be given if hyperactivity may be related to another physical problem.
• An evaluation of intelligence, aptitude, personality traits, or processing skills. These are often done with input from the parents and teachers if the child is of school age.
• A scan called the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, which measures theta and beta brain waves. The theta/beta ratio has been shown to be higher in children and adolescents with ADHD than in children without it.

Several studies have compared ADHD in children of different racial and ethnic groups and found that Black, Hispanic, and Asian children are much less likely than white children to be diagnosed with the disorder. 

There are many reasons for this. Many of these children may not have access to the care they need because of income or racial discrimination. If you fear discrimination or negative treatment, you may be less likely to talk to a health care professional about your child’s symptoms. Cultural and family values may also play a part in how adults respond to their children’s symptoms and whether or not they opt to seek treatment. 

We need more research to better understand all the issues behind these disparities. If you have questions about your child’s symptoms, it may help to learn more about them and what may be causing them. From there, you can plan your next steps. You can get more information about ADHD and other learning and thinking differences at:

• Understood (understood.org)
• American Academy of Child and Adolescent Psychiatry (aacap.org) 
• Children and Adults with Attention-Deficit/Hyperactivity Disorder (chadd.org)

ADHD Treatment

There are several approaches to treating ADHD. But research suggests that for many children, the best way to manage symptoms is a multimodal approach. This involves multiple methods of treatment that work together. Many symptoms of ADHD can be managed with medication and therapy. Close cooperation among therapists, doctors, teachers, and parents is very important.

Medication for ADHD. Although there is controversy about their possible overuse, stimulants are the most commonly prescribed medications for treating ADHD. They can help control hyperactive and impulsive behavior and improve attention span. They act on the brain chemicals, like dopamine, that can make impulsive behavior worse.

They include:

• Amphetamine (Adzenys XR ODT, Dyanavel)
• Dexmethylphenidate (Focalin)
• Dextroamphetamine (Adderall, Dexedrine)
• Lisdexamfetamine (Vyvanse)
• Methylphenidate (Aptensio, Cotempla, Concerta, Daytrana, Jornay PM, Metadate, Methylin, Quillivant, Ritalin)

Stimulant medications don’t work for everyone with ADHD. People older than 6 may take nonstimulant medications such as:

• Atomoxetine (Strattera)
• Clonidine (Catapres, Kapvay)
• Guanfacine (Intuniv)

In some cases, doctors may prescribe antidepressants, such as drugs called SSRIs, bupropion (Wellbutrin), or venlafaxine (Effexor).

Side effects of ADHD medicines can include:

• Anxiety
• Loss of appetite
• Fatigue
• Crankiness
• Trouble sleeping
• Skin discoloration (with patches)
• Upset stomach
• Headache

Most side effects are minor and improve with time. In some cases, doctors may lower a dosage to ease side effects.

In rare cases, stimulants can have more serious side effects. For instance, some are linked to a higher risk of heart problems and death in children with heart disease. They may also make psychiatric conditions like depression or anxiety worse or cause a psychotic reaction.

Before your child starts an ADHD medicine, talk to your doctor about the risks and benefits. Remember that it can take some trial and error to find the right medicine and dose.

Therapy for ADHD. These treatments focus on changing behavior.

• Special education helps a child learn at school. Having structure and a routine can help children with ADHD a lot.
• Behavior modification teaches ways to replace bad behaviors with good ones. Let your child know what behaviors you expect of them. Make simple, clear rules. When they lose control, have them face consequences that you’ve set up, like time-outs or losing privileges. Keep an eye out for good behavior. When they keep their impulses in check, reward them.
• Psychotherapy (counseling) can help someone with ADHD learn better ways to handle their emotions and frustration. It could help improve their self-esteem. Counseling may also help family members better understand a child or adult with ADHD.
• Social skills training can teach behaviors, such as taking turns and sharing. 

Medical devices for ADHD. The FDA has approved the Monarch external Trigeminal Nerve Stimulation (eTNS) System for children 7 to 12 who aren’t taking ADHD medications. It’s about the size of a cellphone and is attached to electrodes on a patch that you put on a child’s forehead. It sends low-level impulses to the part of their brain that’s thought to cause ADHD. The device is usually worn at night.

ADHD support groups of people with similar problems and needs can help you learn more about ADHD and how to manage your symptoms. These groups are helpful for adults with ADHD or parents of children with ADHD.

Education and ADHD. Educating parents about the disorder and its management is another important part of ADHD treatment. This may include learning parenting skills to help a child manage their behavior. In some cases, the child's entire family may be involved.

Natural Remedies for ADHD 

Dietary supplements with omega-3s have shown some benefit for people who have ADHD.

Living With ADHD

A few lifestyle changes can also help you or your child manage symptoms:

• Eat a healthy diet with lots of fruits, veggies, whole grains, and lean protein.
• Get some exercise every day. Studies find that exercise helps control impulses and other behavior problems in kids with ADHD. Think about signing your child up for a sports team, such as basketball, soccer, or baseball. Playing a sport not only gives kids exercise, it teaches them important social skills, such as how to follow rules and take turns.
• Limit time spent on electronic devices.
• Get plenty of sleep.
• Simplify your child's room to lessen distractions, like toys, and improve organization. 

It's common to get frustrated when you're raising a child with ADHD. You’ll feel more in control if you take an active part in your child's treatment. It may help for you to:

• Keep a clear schedule and routines.
• Talk to your child simply and honestly about what you expect from them. Make instructions simple and specific ("Brush your teeth. Now, get dressed.") instead of general ("Get ready for school.").
• Focus only on your child when you’re talking to them.
• Be an example of calm, focused behavior.
• Be consistent with discipline, and make sure other caregivers follow your methods.
• Reward good behavior.
• Boost your child's self-esteem. Because they may have trouble processing directions and other information, they may be bombarded with corrections, leaving them with a low opinion of themselves. Do whatever you can to boost your child's self-esteem.
• Encourage your child's special strengths, particularly in sports and out-of-school activities.
• Learn as much as you can about ADHD and impulsive behaviors.
• Keep in close contact with your child's doctor, teachers, and therapists.
• Join a support group to learn from other parents who have been through the same problems.

ADHD Outlook

Without treatment, ADHD can make it hard to deal with the challenges of everyday life. Children may have trouble learning or developing social skills. Adults could have problems with relationships and addiction. The disorder could also lead to mood swings, depression, low self-esteem, eating disorders, risk-taking, and conflicts with people around you.

But many people who have ADHD live happy, full lives. Treatment helps.

It’s important to keep track of your symptoms and see your doctor regularly. Sometimes, medication and treatments that were once effective stop working. You may need to change your treatment plan. Some people’s symptoms get better in early adulthood, and some are able to stop treatment.