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What
is attention-deficit/hyperactivity disorder?
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.
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.
What
are the 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
- are
forgetful in daily activities
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
- interrupt
or intrude on others
Those
with the combined type, the most common type of ADHD, have
a combination of the inattentive and hyperactive/impulsive
symptoms.
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.
How
common is ADHD?
ADHD affects an estimated two million American children, an
average of at least one child in every U.S. classroom. In
general, boys with ADHD have been shown to outnumber girls
with the disorder by a rate of about three to one. The combined
type of ADHD is the most common in elementary school-aged
boys; the predominantly inattentive type is found more often
in adolescent girls.
While there is no specific data on the rates of ADHD in adults,
the disorder is sometimes not diagnosed until adolescence
or adulthood, and half of the children with ADHD retain symptoms
of the disorder throughout their adult lives. (It is generally
believed that older individuals diagnosed with ADHD have had
elements of the disorder since childhood.)
What
is ADD? Is it different than ADHD?
This is a question that has become increasingly difficult
to answer simply. ADHD, or attention-deficit/hyperactivity
disorder, is the only clinically diagnosed 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. Some use
the term ADD as an umbrella term-after all, ADHD is an attention-deficit
disorder. Others use the term ADD to refer to the predominantly
inattentive type of ADHD, since that type does not feature
hyperactive symptoms. Lastly, some simply use the terms ADD
and ADHD interchangeably. The bottom line is that when people
speak of ADD or ADHD, they generally mean the same thing.
However, only ADHD is the "official" term.
Is
ADHD associated with other disorders?
Yes. In fact, symptoms like those of ADHD are often mistaken
for or found occurring with other neurological, biological,
and behavioral disorders. Nearly half of all children with
ADHD (especially boys) tend to also have oppositional defiant
disorder, characterized by negative, hostile, and defiant
behavior. Conduct disorder (marked by aggression towards people
and animals, destruction of property, deceitfulness or theft,
and serious rule-breaking) is found to co-occur in an estimated
40 percent of children with ADHD. Approximately one-fourth
of children with ADHD (mostly younger children and boys) also
experience anxiety and depression. And, at least 25 percent
of children with ADHD suffer from some type of communication/learning
disability. There is additionally a correlation between Tourette’s
syndrome, a neurobiological disorder characterized by motor
and vocal tics, and ADHD-only a small percentage of those
with ADHD also have Tourette’s, but at least half of
those with Tourette’s also have ADHD. Research is also
beginning to show that ADHD-like symptoms are sometimes actually
manifestations of childhood-onset bipolar disorder.
What
causes ADHD?
First of all, it is important to realize that ADHD is not
caused by dysfunctional parenting, and those with ADHD do
not merely lack intelligence or discipline.
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.
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. 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.
While
early theories suggested that ADHD may be caused by minor
head injuries or brain damage resulting from infections or
complications at birth, research found this hypothesis to
lack substantial supportive evidence. Furthermore, scientific
studies have not verified dietary factors, another widely
discussed possible influence for the development of ADHD,
as a main cause of the disorder.
How
can ADHD be treated?
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.
Medication:
Stimulants are the most widely used drugs for treating attention-deficit/hyperactivity
disorder. The four most commonly used stimulants are methylphenidate
(Ritalin), dextroamphetamine (Dexedrine, Desoxyn), amphetamine
and dextroamphetamine (Adderall), and pemoline (Cylert). 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. Antidepressants,
major tranquilizers, and the antihypertensive clonidine (Catapres)
have also proven helpful in some cases. Most recently, the
FDA has approved a non-stimulant medication, Atomoxetine (Straterra),
a selective norepinephrine reuptake inhibitor for the treatment
of ADHD.
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. Medication has proven effective
in the short-term treatment of more than 76 percent of individuals
with ADHD.
Behavioral
Therapy:
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. Where appropriate, parents should work with the
school district to plan an individualized education program
(IEP).
Other
Treatments:
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, megavitamins, chiropractic adjustment,
and special-colored glasses.
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and supports, and medications;
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