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Attention Deficit Hyperactivity Disorder (ADHD) / ADD


What is ADD and ADHD?

ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for the child's age and development.

Alternative names

ADD; ADHD; Childhood hyperkinesis

Symptoms of ADHD

The Diagnostic and Statistical Manual (DSM-IV) divides the symptoms of ADHD into those of inattentiveness and those of hyperactivity/impulsivity.

To be diagnosed with ADHD, children should have at least 6 attention symptoms or 6 activity/impulsivity symptoms -- to a degree beyond what would be expected for children their age.

The symptoms must be present for at least 6 months, observable in 2 or more settings, and not caused by another problem. The symptoms must be severe enough to cause significant difficulties. Some symptoms must be present before age 7.

Older children who still have symptoms, but no longer meet the full definition, have ADHD in partial remission. Some children with ADHD primarily have the Inattentive Type, some the Hyperactive-Impulsive Type, and some the Combined Type. Those with the Inattentive type are less disruptive and are easier to miss being diagnosed with ADHD.

ADHD

Inattention symptoms

  • Fails to give close attention to details or makes careless mistakes in schoolwork
  • Difficulty sustaining attention in tasks or play
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
  • Difficulty organizing tasks and activities
  • Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
  • Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
  • Easily distracted
  • Often forgetful in daily activities

Hyperactivity symptoms

  • Fidgets with hands or feet or squirms in seat
  • Leaves seat when remaining seated is expected
  • Runs about or climbs in inappropriate situations
  • Difficulty playing quietly
  • Often "on the go", acts as if "driven by a motor", talks excessively

Impulsivity symptoms

  • Blurts out answers before questions have been completed
  • Difficulty awaiting turn
  • Interrupts or intrudes on others (butts into conversations or games)

Signs and tests of ADHD

Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed.

The diagnosis is based on very specific symptoms, which must be present in more than one setting. The child should have a clinical evaluation if ADHD is suspected.

Evaluation may include

  • Parent and teacher questionnaires (Connors, Burks)
  • Psychological evaluation of the child AND family including IQ testing and psychological testing
  • Complete developmental, mental, nutritional, physical, and psychosocial examination

Causes, incidence, and risk factors of ADHD

ADHD affects school performance and relationships with others. Parents of children with ADHD are often exhausted and frustrated. Scientific studies, using advanced neuroimaging techniques of brain structure and function, show that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters (including dopamine, serotonin, and adrenalin) differently from their peers.

ADHD is often genetic. Whatever the specific cause may be, it seems to be set in motion early in life as the brain is developing.

Depression, sleep deprivation, learning disabilities, tic disorders, and behavior problems may be confused with, or appear along with, ADHD. Every child suspected of having ADHD deserves a careful evaluation to sort out exactly what is contributing to the concerning behaviors.

Attention Deficit Disorder (ADD) is the most commonly diagnosed behavioral disorder of childhood, affecting an estimated 3 - 5% of school aged children. It is diagnosed much more often in boys than in girls. Most children with ADHD also have at least one other developmental or behavioral problem.

Treatment for ADHD

There is no "cure" for ADHD, however, many treatment approaches may alleviate or significantly decrease ADHD symptoms. As a result, improvements are evident in school/work performance, relationships with others improve, and self esteem increases.

No single treatment works for every individual. Treatment options should be explored with a health care provider who will consider the patient's needs, and family, medical, and personal history. Some people respond well to medications, some to behavioral interventions, many respond to a combination of the two. Counseling, education, and support services are often helpful. Typically, a multimodal approach to treatment works best.

Complications of ADHD

There are a high number of adults with ADHD who are in successful jobs. Possible complications, if ADHD is not adequately treated, could include failure in school or other similar problems.

Prevention of ADHD

While there is no proven way to prevent ADHD itself, early identification and treatment can prevent many of the problems associated with ADHD.

Adult ADHD

Adults with ADHD have typically had the disorder since childhood, but it may not have been diagnosed until later in life; an evaluation usually occurs at the prompting of a peer, family member, or coworker who has observed problems at work or in relationships. Adult ADHD symptoms can be somewhat different than those experienced by children. For example, adults with predominantly hyperactive-impulsive ADHD are unlikely to run and jump around. Generally, ADHD has a less severe profile in adults than in children, but there is still some debate about accurately diagnosing adult ADHD.


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