Attention-Deficit Hyperactivity

Definition

Attention-deficit hyperactivity disorder, or ADHD, is a developmental

disorder usually associated with children but increasingly recognized

in adults too. People with ADHD are easily distracted, have trouble

focusing or paying attention, are disorganized, and frequently behave in

impulsive ways.

The disorder has been known to doctors for over a century. The earliest

description of it was written by a German doctor in 1845, about his

own son. In 1902 a British doctor named George Still gave a series of lectures

to other doctors, in which he described children who would now be

called hyperactive and impulsive. Still thought that the disorder might be

genetic in origin. He emphasized the fact that the behavioral problems in

these children did not result from bad parenting.

There are three basic types of ADHD: inattentiveness; impulsiveness;

and a combination of the two.

Description

The central characteristic of all three types of ADHD is that the child (or

adult) diagnosed with the disorder has fallen behind in school and in social

relationships. Children diagnosed with the inattentive type of ADHD daydream

in school; do not seem to listen when someone speaks directly to

them; do not follow instructions and fail to complete chores or homework

assignments; have trouble with tasks that require concentration; and are in

general disorganized. They are more easily overlooked by parents and teachers,

however, because their behavior is not as disruptive as the hyperactivity

or impulsiveness of other children diagnosed with ADHD.

Children diagnosed with the hyperactive or impulsive type of ADHD

are the ones who cannot sit still in school. They call out answers or talk all

the time, get up and walk around the room, or try to do several things at

once. They do not think before they speak, act without considering the

consequences of their actions, or have trouble taking turns with other children.

Teenagers with this type of ADHD may say that they feel inwardly

restless much of the time or need to find things to do to keep busy.

One important thing to keep in mind about ADHD is that the

behaviors

both

months or longer. Not every episode of absentmindedness or fidgeting in

school means that a child has ADHD. In addition, children

differ, including their level of activity and their level of interest in

certain activities. For example, some children have no difficulty finishing

their homework in a subject that interests them but may have trouble

focusing on an assignment in a subject they do not like.

The signs of ADHD in adults are often harder to recognize than in

children. Adults with ADHD are more likely to say that they have

trouble relaxing than feeling that they have to race around physically.

Inattentiveness may take the form of forgetting meetings, work deadlines,

or social get-togethers. Impulsiveness may take the form of moodiness,

temper tantrums, or impatience in traffic jams.

—whether inattentiveness, hyperactivity, or a combination of—must be inappropriate to the child’s age and must continue for six’s personalities

Demographics

According to the National Institute of Mental Health (NIMH), between

3 and 7 percent of children in the United States have ADHD. This group

would include about 2 million children as of 2008. Worldwide, the rate of

ADHD in children is thought to be somewhere between 8 and 12 percent.

Boys are three to five times more likely than girls to be diagnosed

with ADHD. The inattentiveness subtype is more common in girls than

in boys, however. As far as is known, ADHD is equally common in all

racial and ethnic groups in the United States.

In adults, the gender ratio is virtually equal. The rate of ADHD in

American adults is thought to be between 2 and 7 percent.

Causes and Symptoms

The causes of ADHD are not completely understood, but studies of brain

function using positron emission tomography (PET) scans indicate that

the brains of children with ADHD may be structured differently from

those of children without the disorder. More specifically, some

researchers think that the parts of the brain that govern attentiveness do

not have normal levels of dopamine, a chemical produced by the brain

that allows nerve cells to transmit signals from one cell to another. The

fact that medications that stimulate the release of dopamine are beneficial

to children with ADHD supports this theory.

There are also genetic factors involved in ADHD even though no

specific gene has been identified as a cause of the disorder. It is known

that the disorder runs in families. The parents and siblings of children

with ADHD are two to eight times more likely to develop ADHD than

the general population.

Some researchers think that environmental toxins, particularly lead,

and a mother

ADHD in the child. There is also some evidence that very low birth

weight or premature birth may be risk factors for ADHD. It is not known

whether the emotional climate in the child

although some doctors think that mood or anxiety disorders in

other family members may make the child

unproven theories include the idea that ADHD is caused by head injuries,

allergic reactions to food additives, or a diet high in sugary foods.

Symptoms of inattentiveness related to ADHD include:

’s drinking or smoking during pregnancy are risk factors for’s family contributes to the disorder,’s symptoms worse. Other

•

mistakes.

Failing to pay close attention to details; frequently making careless

•

minutes.

Having difficulty paying attention to tasks for more than a few

•

Appearing not to listen when spoken to.

•

homework or other tasks.

Not following through on instructions and failing to complete

•

Having difficulty organizing tasks.

•

homework or other tasks.

Frequently losing pencils, books, or other items necessary to complete

•

Being forgetful.

•

Symptoms of impulsiveness and hyperactivity include:

Being easily distracted.

•

Fidgets or squirms in seat.•

•

Has difficulty playing quietly.

•

Seems to be constantly on the go.

•

Talks a lot; finds it hard to keep quiet.

•

Blurts out answers in class.

•

Finds it hard to take turns or wait in line.

•

Butts in on conversations or intrudes on the privacy of others.

Diagnosis

The diagnosis of ADHD is complicated, not only because the child

overall personality, and medical history must be taken into account, but

also because about 45 percent of children with ADHD have at least one

other psychiatric disorder, most commonly anxiety disorders, depression,

Tourette syndrome, or bipolar disorder. There is no single laboratory test,

imaging study, or neurological test that can be used to diagnose ADHD,

although there are behavioral checklists and questionnaires that doctors

can use to narrow the diagnostic possibilities. The diagnosis usually follows

a series of interviews with psychiatrists and psychologists as well as

the child

to rule out vision problems, hearing loss, seizure disorder, or hyperthyroidism

as possible causes of the child

The diagnosis of ADHD in children is based on whether the child

meets the criteria specified in a diagnostic manual on mental disorders:

’s age,’s pediatrician. A complete physical examination is important’s behavior.

•

years old.

The symptoms must have started before the child was seven

•

months.

The child must have had the symptoms over a period of at least six

•

or hyperactivity/impulsiveness listed in the previous section.

The child must have six ormore of the signs or symptoms of inattentiveness

•

to function in at least two areas of life, usually home, relationships

with friends, and schoolwork. Thus, a child who is impulsive or

inattentive at school but relates well to friends or other family

members would not be diagnosed with ADHD.

A set of criteria called the Wender Utah Rating Scale is commonly

used to diagnose ADHD in adults:

The symptoms must be shown to have affected the child’s ability

•

A history of ADHD in childhood•

•

Difficulty completing tasks

•

Mood swings

•

Difficulty controlling temper

•

Inability to handle stress

•

Impulsive behaviors

Treatment

Treatment for ADHD usually includes a combination of medications

and behavior therapy. The use of medications has been controversial.

However, children treated with both medications and behavior therapy

have been found to do better than those treated with behavior therapy

alone. It is important to understand that the medications prescribed for

ADHD do not cure the disorder. The medications only help the child

control the symptoms, and they must be taken every day.

The medications most commonly used to treat ADHD are psychostimulants,

which work by targeting the parts of the brain that produce

dopamine. These drugs include Ritalin, Adderall, and Dexedrine. More

recently, the Food and Drug Administration (FDA) approved the use

of a non-stimulant medication called Strattera, which works on another

brain chemical called norepinephrine. Norepinephrine is a hormone that

affects a person

stress. Although medications for ADHD generally work well, they do

have side effects, such as sleep problems, weight loss, appetite loss, and

nervousness.

In addition to behavior therapy, children with ADHD may receive

social skills training and attend support groups. Many doctors recommend

parenting skills training for the parents of children with ADHD

and family therapy for the entire family.

Adults with ADHD are also treated with a combination of drugs and

psychotherapy. However, because adults need larger doses of psychostimulants

than children do, they must see their doctor periodically to make

sure that the drugs are not interfering with other medications they may

be taking, particularly drugs to control high blood pressure.

Some forms of alternative medicine that have been suggested as

treatments for ADHD include special diets, vitamin supplements, and

various herbal preparations. There is no evidence, however, that any

of these alternative approaches are useful for children or adults with the

disorder.

Prognosis

Doctors think that between 30 and 70 percent of children diagnosed

with ADHD will continue to have some symptoms of the disorder as

adults. Most children diagnosed with the disorder benefit from appropriate

treatment, although they have a higher risk of alcohol and drug

abuse in adolescence. As many as 65 percent may continue to have problematic

symptoms of ADHD that keep them from reaching their full

academic or work potential in adult life.

Prevention

There is no known way to prevent ADHD because the causes of the disorder

are still not completely understood.

The Future

Doctors are not certain whether the rate of ADHD in the American

population is likely to increase or remain at its present level. Current

research on the disorder includes studies comparing newer drugs for

ADHD to older psychostimulants; studies of ADHD in adults; studies

of the relationship of childhood ADHD to substance abuse in adolescence

and adulthood; and evaluations of new diagnostic questionnaires

for ADHD.

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