Attention-deficit/hyperactivity disorder (ADHD) is an illness characterized by inattention, hyperactivity and impulsivity. The most commonly diagnosed behavior disorder in young persons, ADHD affects an estimated three percent to five percent of school-age children and according to APGAR studies can be detected in infancy.
Although ADHD is usually diagnosed in childhood, it is not a disorder limited to children—ADHD often persists into adolescence and adulthood and is frequently not diagnosed until later years.
Symptoms of ADHD:
There are actually three different types of ADHD, each with different symptoms: predominantly inattentive, predominantly hyperactive/impulsive and combined.
Those with the predominantly inattentive type often:
• fail to pay close attention to details or make careless mistakes in schoolwork, work or other activities
• have difficulty sustaining attention to tasks or leisure activities
• do not seem to listen when spoken to directly
• do not follow through on instructions and fail to finish schoolwork, chores or duties in the workplace
• have difficulty organizing tasks and activities
• avoid, dislike or are reluctant to engage in tasks that require sustained mental effort
• lose things necessary for tasks or activities
• are easily distracted by extraneous stimuli; and/or
Those with the predominantly hyperactive/impulsive type often:
• fidget with their hands or feet or squirm in their seat
• leave their seat in situations in which remaining seated is expected
• move excessively or feel restless during situations in which such behavior is inappropriate
• have difficulty engaging in leisure activities quietly
• are "on the go" or act as if "driven by a motor"
• talk excessively
• blurt out answers before questions have been completed
• have difficulty awaiting their turn; and/or
• interrupt or intrude on others
What is needed to make a diagnosis of ADHD:
A diagnosis of ADHD is made when an individual displays at least six symptoms from either of the above lists, with some symptoms having started before age seven. Clear impairment in at least two settings, such as home and school or work, must also exist. Additionally, there must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
ADD vs ADHD:
ADHD or attention-deficit/hyperactivity disorder, is the only clinical term for disorders characterized by inattention, hyperactivity and impulsivity used in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, the diagnostic "bible" of psychiatry. However (and this is where things get tricky), ADD, or attention-deficit disorder, is a term that has become increasingly popular among laypersons, the media and even some professionals.
ADHD is associated with other disorders:
In fact, symptoms like those of ADHD are often mistaken for or found occurring with other neurological, biological and behavioral disorders. Often ADD or ADHD are comorbid with another primary or secondary disorder. It is the trained practitioner's job to discern which disease is the the base or primary disease.
• Anxiety and depression: Approximately one-fourth of children with ADHD (mostly younger children and boys) also experience anxiety and depression.
• Communication/learning disability: At least 25 percent of children with ADHD have some type of communication/learning disability.
• Tourette's syndrome: There is additionally a correlation between Tourette’s syndrome, a neurobiological disorder characterized by motor and vocal tics and ADHD—a small percentage of those with ADHD also have Tourette’s, but at least half of those with Tourette’s also have ADHD.
• Bipolar disorder: Research is also beginning to show that ADHD-like symptoms are sometimes actually manifestations of childhood-onset bipolar disorder.
Causes of ADHD:
• Biological basis: Strong scientific evidence supports the conclusion that ADHD is a biologically based disorder. Recently, National Institute of Mental Health researchers using PET scans have observed significantly lower metabolic activity in regions of the brain controlling attention, social judgment and movement in those with ADHD than in those without the disorder. Biological studies also suggest that children with ADHD may have lower levels of the neurotransmitter dopamine in critical regions of the brain.
• Prenatal issues: Other theories suggest that cigarette, alcohol and drug use during pregnancy or exposure to environmental toxins such as lead may be linked to the development of ADHD. Environmental issues can also cotribute to this condition as well - anxiety and high stressful situations "can" be contributing factors.
• Genetic basis: Research also suggests a strong genetic basis to ADHD—the disorder tends to run in families. In addition, research has shown that certain forms of genes related to the dopamine neurotransmitter system are linked to increased likelihood of the disorder. More recent studies are showing more evidence for a genetic grounding of ADHD.
Many treatments—some with good scientific basis, some without—have been recommended for individuals with ADHD. The most proven treatments are medication and behavioral therapy.
Stimulants are the most widely used drugs for treating attention deficit/hyperactivity disorder. Examples of the most commonly used stimulants are methylphenidate (Ritalin), dextroamphetamine (Dexedrine, Desoxyn), amphetamine and dextroamphetamine (Adderall). Some of the stimulant class of medications come in longer acting preparations and can be given once a day. These drugs increase activity in parts of the brain that are underactive in those with ADHD, improving attention and reducing impulsiveness, hyperactivity and/or aggressive behavior. Stimulants have been shown to have the potential for abuse and are classified as controlled substances. The FDA has also approved a non-stimulant medication, Atomoxetine (Straterra), which does not appear to have the same risk of abuse as the stimulants. Even a few cups of coffee can help with ADHD in extremely minor cases.
Other medications can be prescribed for ADHD but are done so “off label” which means the FDA has not approved the medication for this particular use in children and adolescents. If the doctor is making that recommendation, ask him or her why and what research and clinical experience inform that recommendation. You may get a second opinion from another doctor if you are not satisfied with the answers.
Every person reacts to treatment differently, so it is important to work closely and communicate openly with your physician. Some common side effects of stimulant medications include weight loss, decreased appetite, trouble sleeping and, in children, a temporary slowness in growth; however, these reactions can often be controlled by dosage adjustments. There is controversy about a serious possible heart complication that can occur in a small percent of people who take stimulants. Tics, or involuntary movement problems, are not common but can be uncomfortable side effects.
It is important to weigh the risks and benefits of these treatments with your doctor and youth. Medication has proven effective in the short-term treatment of about three quarters of individuals with ADHD.
Treatment strategies such as rewarding positive behavior changes and communicating clear expectations of those with ADHD have also proven effective. Additionally, it is extremely important for family members and teachers or employers to remain patient and understanding.
Children with ADHD can additionally benefit from caregivers paying close attention to their progress, adapting classroom environments to accommodate their needs and using positive reinforcers. There is some evidence that behavioral treatment can lower the dose of the medications a child requires.
There are a variety of other treatment options offered (some rather dubious) for those with ADHD. Those treatments not scientifically proven to work include biofeedback, special diets, allergy treatment, mega vitamins, chiropractic adjustment and special-colored glasses.
Many children with ADHD also have co-occurring learning disabilities. Evaluation of a child’s learning style and strengths may be advisable to better match classroom and other supports with their learning style.
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This article is for informational purposes only and not to be used in diagnosing or treating any potential illness