About ADHD
Attention Deficit Hyperactivity Disorder
 Attention
Deficit Hyperactivity Disorder (ADHD) is a condition
that becomes apparent in some children in the preschool
and early school years. It is hard for these children to
control their behavior and/or pay attention. It is
estimated that between 3 and 5 percent of children have
ADHD, or approximately 2 million children in the United
States. This means that in a classroom of 25 to 30
children, it is likely that at least one will have ADHD.
ADHD was first described
by Dr. Heinrich Hoffman in 1845. A physician who wrote
books on medicine and psychiatry, Dr. Hoffman was also a
poet who became interested in writing for children when
he couldn't find suitable materials to read to his
3-year-old son. The result was a book of poems, complete
with illustrations, about children and their
characteristics. "The Story of Fidgety Philip" was an
accurate description of a little boy who had attention
deficit hyperactivity disorder. Yet it was not until
1902 that Sir George F. Still published a series of
lectures to the Royal College of Physicians in England
in which he described a group of impulsive children with
significant behavioral problems, caused by a genetic
dysfunction and not by poor child rearing—children who
today would be easily recognized as having ADHD. Since
then, several thousand scientific papers on the disorder
have been published, providing information on its
nature, course, causes, impairments, and treatments.
A child with ADHD faces a
difficult but not insurmountable task ahead. In order to
achieve his or her full potential, he or she should
receive help, guidance, and understanding from parents,
guidance counselors, and the public education system.
This document offers information on ADHD and its
management, including research on medications and
behavioral interventions, as well as helpful resources
on educational options.
Diagnosis of Attention
Hyperactivity Deficit Disorder
In the most current assessment guidelines published by the
American Psychiatric Association, Diagnostic and Statistical Manual for Mental
Disorders IV (DSM4), the disorder is known as ADHD and has several types
including: (1) predominantly inattentive; (2) predominantly impulsive or (3)
combined. Individuals with this condition usually have many (but not all) of the
following symptoms:
Inattention:
- often fails to finish what he starts
- doesn’t seem to listen
- easily distracted
- has difficulty concentration or paying attention
- doesn’t stick with a play activity
Impulsivity:
- often acts without thinking & later feels sorry
- shifts excessively from one activity to another
- has difficulty organizing work
- needs a lot of supervision
- speaks out loud in class
- doesn’t wait to take turns in games or groups
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Hyperactivity:
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runs about or climbs on things excessively
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can’t sit still and is fidgety
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has difficulty staying in his seat and bothers
classmates
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excessive activity during sleep
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always on the "go" and acts as if "driven"
Emotional Instability:
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angry outbursts
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social loner
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blames others for problems
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fights with others quickly
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very sensitive to criticism
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The diagnosis is made by "ruling out" other medical or
psychiatric causes for the symptoms and by then determining that the patient
meets the DSM4 criteria for ADHD. Psychological testing can be useful to rule
out learning disabilities and Continuous Performance Tests (Connor’s CPT, TOVA,
IVA, Gordon Diagnostic) may help confirm the diagnosis and be helpful with
titration of medication. At this time the use of imaging such as PET or SPECT
is recommended for research purposes. Several professional organizations
recommend against the use of these techniques due to unwarranted exposure to
radiation and lack of sufficient data to enable accurate diagnosis.
ADHD may coexist with anxiety, depression, Tourette’s,
bipolar disorder, conduct and learning disabilities.
True ADHD patients usually start showing symptoms by the
time they start school. Some very impulsive children are diagnosed as early as 2
or 3 years old. Another group appears to develop more severe symptoms around the
fourth grade. These children may have always had ADHD but were able to
compensate for the condition. As school requires more work and more organization
skills, these children may reach a point where they become unable to compensate
and exhibit "full blown" ADHD symptoms. Some children may remain undiagnosed
until they are in their teens. More recently adults have been diagnosed as
having Attention Deficit Disorder. These individuals had the disorder as
children but were not properly identified during their childhood. [More
Information See: Symptoms -
Diagnosis]
Causes of Attention Deficit
Hyperactivity Disorder
 The symptoms of ADHD are caused by a neurological
dysfunction within the brain. Several studies using PET scans have confirmed
that there is a definite difference in brain functioning between a group of
individuals diagnosed with ADHD and those without it. The underlying
physiological mechanism which causes ADHD is still not thoroughly understood and
remains under scientific study.
ADHD may be either inherited (70%) or acquired (30%).
Recent research in genetics has definitely shown that ADHD runs in families.
ADHD may be acquired through various conditions that cause insult (damage) to
the brain. During pregnancy and delivery these include the use of drugs during
pregnancy, smoking during pregnancy, toxemia, infectious diseases, overexposure
to radiation, prematurity, complicated delivery. After birth these include
meningitis, encephalitis, seizures from fever, head injury and lead toxicity.
[More on Causes]
Treatment of ADHD
Medications such as stimulants have long been employed in
the treatment of Attention Deficit Disorder. These medications improve a
chemical imbalance in the brain which is causing the symptoms. A number of neuro-imaging
studies have shown that the brain functioning of ADHD patients does improve and
appears to be more like the normal group after they have taken their prescribed
medication.
Medications usually used to treat ADHD improve the
availability in the synapse of two neurotransmitters, dopamine and
norepinephrine. Specific neurotransmitters (brain chemicals) are necessary to
carry a nerve impulse (message) along a neuropathway (circuit). When a
neurotransmitter is not fully available, a message may be stopped short of its
intended destination. When this happens, the function regulated by that circuit
may not work as well as it should.
 Medications that treat ADHD are not tranquilizers or
sedatives. They do not slow down the nervous system. They actually improve
functioning in various areas of the brain involved with attention, concentration
and self-control. Over 200 well controlled studies have shown that these
medications are the safest and most effective psychiatric medications. Failure
to treat ADHD with medications may result in increased risk of substance abuse
and decreased white matter volumes in the brain.
Common ADHD Medications:
In difficult cases antidepressants or anti-hypertensive
medications may be used. [More on
Medications]
There is no scientific evidence to support the use of diet,
supplements or biofeedback as treatment. Medication is the most frequently
employed treatment method for ADHD. It is often employed along with
psychological techniques such as behavior modification and patient/family
education. For an objective review please see
Complementary and Alternative Treatments from National Resource
Center on ADHD.
The American Academy of Pediatrics (AAP) recommends that
treatment for the disorder should consist of a comprehensive plan using
MEDICATION AND OR PSYCHOLOGICAL TREATMENT. Children with mild to moderate
symptoms may ONLY NEED PSYCHOLOGICAL INTERVENTIONS to show significant
improvement. The treatment should involve the physician, child, parents, family
members and school personnel working together. The basics of the treatment plan
must be carried out consistently for a long period of time (years) in order for
maximum and enduring benefits to be achieved. For a review of recommended
psychological interventions see
Psychological Treatment for Children and Adolescents from National
Resource Center on ADHD and
Evidence-Based Psychological Treatment for Children from Child
Development Institute.
Due to cost and time factors significant Psychological
Treatment interventions are often overlooked. Child Development Institute
recognized this and has produced a multi-media program known as
Total Focus™ that involves the
parents and children working together as a team to help the child achieve
success at school and enjoy life at home and in the community. The program is
based on 20 years of clinical experience of the author and is produced by a
leading publisher of parenting programs. This cost effective, evidenced based
program provides workbook materials and audio lessons and even a temperature
biofeedback devise for use by both parents and kids that teach coping skills
based on proven treatment strategies including:
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Parent Education
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Behavior Modification Programs for Home and School
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Relaxation Training to Improve Emotional Control
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Cognitive Behavioral Therapy to Improve Motivation,
Problem Solving Skills and Self-Esteem
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Fun Cognitive Rehabilitation Exercises (Brain Training)
to Improve Attention, Concentration and Executive Functioning
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Parent Coached Social Skill Training
Complete, easy to follow instructions are provided along
with numerous questionnaires, charts and handouts for implementing behavior
change programs and monitoring progress. Even telephone coaching by mental
health professionals trained by the author of the program is available when
desired. [More on Total Focus]
Long Term Outlook for Individuals
With Attention Deficit Hyperactivity Disorder
When properly treated, children and adolescents with ADHD
can lead very normal and productive lives. In fact, many traits found in
individuals with ADHD can help them to become very successful later in life. It
should be noted that a loving, supportive and consistent environment is
essential for the positive growth and develop of all children and especially
those with ADHD or other learning disabilities. People with ADHD tend to have
average or above average intelligence. They are often very creative and usually
have a high energy level. These individuals also are frequently very sensitive
and highly affectionate.
In the last few years, it has become more likely for adults
to be diagnosed with ADHD and start on medication. These may be individuals who
were not properly identified when they were children. In other cases, adults
have learned to compensate for their disorder and become very successful
individuals. In fact, some may "over compensate" and become extraordinarily
successful.
Additional Support
Parents can benefit greatly by participating in a support
group along with other parents of ADHD kids. Parents should refer to nationally
recognized Support Organizations and trusted
Professional Associations for reliable information and effective support.
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