About ADD / ADHD -Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder – ADHD sometimes known as Attention Deficit Disorder – ADD 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 meet criteria for diagnosis, 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.

The condition 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 the condition 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

Hyperactivity:

• runs about or climbs on things excessively
• can’t sit still and is fidgety
• has difficulty staying in his seat and bothers classmates
• excessive activity during sleep
• always on the “go” and acts as if “driven”

Emotional Instability:

• angry outbursts
• social loner
• blames others for problems
• fights with others quickly
• very sensitive to criticism

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.

This diagnosis may coexist with anxiety, depression, Tourette’s, bipolar disorder, conduct disorder 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 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 behind the causes is still not thoroughly understood and remains under scientific study.

The disorder may be either inherited (70%) or acquired (30%). Recent research in genetics has definitely shown that the condition 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]

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