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previously known as '''Attention Deficit Disorder (ADD)''', is generally considered to be a . Methods of treatment usually involve some combination of medication, behaviour modification, life style changes, and counseling. Certain social critics are highly skeptical that the diagnosis denotes a genuine impairment and question virtually all that is known about ADHD. The symptoms of ADHD are not as profoundly different from normal behavior as are those of other chronic
Mental Disorder s. Still, ADHD has been shown to often impair functioning, and many adverse life outcomes are associated with ADHD.
ADHD is a
Developmental Disorder that is often said to be neurological in nature. The term "developmental" means that certain traits such as
Impulse Control significantly lag in development when compared to the general population. This developmental lag has been estimated to range between 30-40 percent in ADHD sufferers in comparison to their peers; consequently these delayed attributes are considered an impairment. ADHD has also been classified as a
Behavior Disorder and a
Neurological Disorder or combinations of these classifications such as neurobehavioural or
Neurodevelopmental Disorders . These compounded terms are now more frequently used in the field to describe the disorder. The behavioral classification for ADHD is not completely accurate in that those with Predominately Inattentive ADHD often display few or no overt behaviors.
Based on
DSM-IV criteria, three types of ADHD are identified:
- 1. ADHD, Combined Type: if both criteria 1A and 1B are met for the past 6 months
- 2. ADHD Predominantly Inattentive Type: if criterion 1A is met but criterion 1B is not met for the past six months
- 3. ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion 1B is met but Criterion 1A is not met for the past six months.
ICD
In the tenth edition of the ''. Retrieved on
December 11 ,
2006 .) is present, the condition is referred to as "Hyperkinetic conduct disorder". Otherwise the disorder is classified as "Disturbance of Activity and Attention", "Other Hyperkinetic Disorders" or "Hyperkinetic Disorders, Unspecified". The latter is sometimes referred to as, "Hyperkinetic Syndrome".
The
American Academy Of Pediatrics Clinical Practice Guideline for children with ADHD emphasizes that a reliable diagnosis is dependent upon the fulfillment of three criteria:Perrin JM, Stein MT, Amler RW, Blondius TA. 2001. "Clinical practice guideline: treatment of school-aged children with Attention Deficit/Hyperactivity Disorder". ''Pediatrics'' 108 (4):1033-1044. PMID 11581465
- The use of explicit criteria for the diagnosis using the DSM-IV-TR .
- The importance of obtaining information about the child’s symptoms in more than one setting.
- The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.
The first criteria can be satisfied by using an ADHD-specific instrument such as the Conners' Rating Scale.
1 The second criteria is best fulfilled by examining the individual's history. This history can be obtained from parents and teachers, or a patient's memory.Ratey, John; Hallowell, Edward. ''Driven to Distraction'' first edition, p. 42 The requirement that symptoms be present in more than one setting is very important because the problem may not be with the child, but instead with teachers or parents who are too demanding. The use of
Intelligence Test ing,
Psychological Testing , and
Neuropsychological Test ing (to satisfy the third criteria) is essential in order to find or rule out other factors that might be causing or complicating the problems experienced by the patient.Ninivaggi, F. J. "Borderline intellectual functioning and academic problem." In: Sadock B.J. Sadock, V.A., eds. ''Kaplan & Sadock's Comprehensive Textbook of psychiatry. 8th ed.'' Vol. II. Baltimore: Lippincott William and Wilkins; 2005: 2272–76.
The
Centers For Disease Control And Prevention (CDC) state that a diagnosis of ADHD should only be made by trained health care providers, as many of the symptoms may also be part of other conditions, such as bodily illness or other physiological disorders, such as
Hyperthyroidism . It is not uncommon that physically and mentally
Nonpathological individuals exhibit at least some of the symptoms from time to time. Severity and pervasiveness of the symptoms leading to prominent functional impairment across different settings (school, work, social relationships) are major factors in a positive diagnosis.
Adults often continue to be impaired by ADHD. Adults with ADHD are diagnosed under the same criteria, including the stipulation that their symptoms must have been present prior to the age of seven.
Attention-Deficit/Hyperactivity Disorder. Psychiatry Online. Retrieved on .
Common comorbid conditions are
Oppositional Defiance Disorder (ODD). About 20% to 25% of children with ADHD meet criteria for a
Learning Disorder .
2 Learning disorders are more common when there are inattention symptoms.
3
The exact cause of ADHD remains unknown and in all probability ADHD is a heterogeneous disorder, meaning that several causes could create very similar symptomology. Still, there is a wide body of evidence which indicates that the overriding cause of ADHD is genetics. Research suggests that a large majority of ADHD arises from a combination of various genes, many of which affect transporters in the
Striatum which is in charge of planning ahead.
45
A study by the U.S. Department of Energy’s
Brookhaven National Laboratory in collaboration with
Mount Sinai School Of Medicine in New York suggest that it is not the dopamine transporter levels that indicate ADHD, but the brain's ability to produce dopamine itself. The study was done by injecting 20 ADHD subjects and 25 control subjects with a radiotracer that attaches itself to dopamine transporters. The study found that it was not the transporter levels that indicated ADHD, but the dopamine itself. ADHD subjects showed lower levels of dopamine across the board. They speculated that since ADHD subjects had lower levels of dopamine to begin with, the number of transporters in the brain was not the telling factor. In support of this notion, plasma
Homovanillic Acid , an index of dopamine levels, was found to be inversely related not only to childhood ADHD symptoms in adult psychiatric patients, but to "childhood learning problems" in healthy subjects as well.
6
An early
PET Scan study found that global cerebral
Glucose Metabolism was 8.1% lower in medication-naive adults who had been diagnosed as ADHD while children. The image on the right illustrates glucose metabolism in the brain of a 'normal' adult while doing an assigned auditory attention task; the image on the right illustrates the areas of activity in the brain of an adult who had been diagnosed with ADHD as a child when given that same task; these are not pictures of individual brains, which would contain substantial overlap, these are images constructed to illustrate group-level differences. Additionally, the regions with the greatest deficit of activity in the ADHD patients (relative to the controls) included the
Premotor Cortex and the superior
Prefrontal Cortex . A second study in adolescents failed to find statistically significant differences in global glucose metabolism between ADHD patients and controls, but did find statistically significant deficits in 6 specific regions of the brains of the ADHD patients (relative to the controls). Most notably, lower metabolic activity in one specific region of the left anterior
Frontal Lobe was significantly inversely correlated with symptom severity.Zametkin AJ, Liebenauer LL, Fitzgerald GA,, et al. "Brain metabolism in teenagers with attention-deficit hyperactivity disorder." ''Arch Gen Psychiatry.''. 1993 May 50;333(5). PMID 2233902 These findings strongly imply that lowered activity in specific regions of the brain, rather than a broad global deficit, is involved in ADHD symptoms. However, these readings are of subjects doing an ''assigned task.'' They could be found in ADHD diagnosed patients because they simply were not attending to the task. Hence the parts of the brain used by others doing the task would not show equal activity in the ADHD patients.
The estimated contribution of non genetic factors to the contribution of all cases of ADHD is 20 percent. SchwabLearning.org. The environmental factors implicated are common exposures and include alcohol, ''in utero'' tobacco smoke and lead exposure. Lead concentration below the (lack of oxygen) ''in utero'', but it could also be that ADHD women have more probabilities to smoke both in general and during pregnancy, being more likely to have children with ADHD due to genetic factors.
Head injuries can cause a person to present ADHD-like symptoms,McAvinue L, O'Keeffe F, McMackin D, Robertson IH, et al. "Impaired sustained attention and error awareness in traumatic brain injury: implications for insight" ''Neuropsychological Rehabilitation''. 2005 Dec;15(5):569–87. PMID 16381141 possibly because of damage done to the patient's frontal lobes. Because these types of symptoms can be attributable to brain damage, the earliest designation for ADHD was "Minimal Brain Damage".
What Causes AD/HD. Attention Deficit Disorder Association. Retrieved on
2007-08-13 .
There is no compelling evidence that social factors alone can create ADHD. Many researchers believe that attachments and relationships with caregivers and other features of a child's environment have profound effects on attentional and self-regulatory capacities. It is noteworthy that a study of foster children found that an inordinate number of them had symptoms closely resembling ADHD. An editorial in a special edition of can result in attention problems that can look like ADHD, as can
Sensory Integration Disorders .
Despite the lack of evidence that nutrition ''causes'' ADHD, studies have found that malnutrition is correlated with attention deficits.Galler JR, Ramsey F. "A follow-up study of the influence of early malnutrition on development: behavior at home and at school." ''J Am Acad Child Adolesc Psychiatry''. 1989 Mar;28(2):254–61. PMID 2494148
See Also: Attention-deficit hyperactivity disorder treatments
There are several clinically proven effective options available to treat people diagnosed with ADHD. ADHD is treated most effectively, and cost efficiently, with medication.
8 Free full text Psychotherapy is another option, with or without medicationBarkley, R. (2005) ''Take Charge of ADHD: The Complete Authoritative Guide for Parents''. NY: Guilford Publications Omega-3 fatty acids, zinc, and magnesium may have benefits with regards to ADHD symptoms.
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Comorbid disorders or substance abuse can make finding the proper diagnosis and the right overall treatment more costly and time-consuming.
11
ADHD is a developmental disorder meaning that certain traits will be delayed in the ADHD individual. These traits will develop but just at a much slower rate than the average person. With ADHD it has been estimated that this lag could be as high as thirty to forty percent in the development of impulse control. Symptoms of ADHD are often seen by the time a child enters preschool. Those with ADHD typically have a greater degree of parent-child conflict and emotional reactivity. The incident of speech problems, central auditory processing difficulties, and coordination problems are all higher than that of the general population. A marked decrease in academic skills such as reading, spelling, or math is common with children who have ADHD.
During the elementary years an ADHD student will have more difficulties with work completion, productivity, planning, remembering things needed for school, and meeting deadlines. Oppositional and socially aggressive behaviour is seen in 40-70 percent of children at this age. Even ADHD kids with average to above average intelligence show "chronic and severe underachievement". Fully 46% of those with ADHD have been suspended and 11% expelled. Thirty seven percent of those with ADHD do not get a high school diploma even though many of them will receive special education services. The combined outcomes of the expulsion and dropout rates indicate that almost half of all ADHD students never finish highschool. Only five percent of those with ADHD will get a college degree compared to twenty seven percent of the general population. (
US Census , 2003)
Social impairment for those with ADHD are seen at both school and work. They often have more troubled relationships with peers or family members. At the workplace they change jobs more often and are more likely to get fired. Their income level does not rise as quickly as their peers even when education level, IQ, and their neighborhood is accounted for. Thirty five percent of all ADHDers will be self employed in their mid-thirties. Those with ADHD are at greater risk of: injury, abnormal risk taking, smoking, having learning disabilities, other mental disorders, ,
1999 . Retrieved on
2007-08-13 .
There is no known way to prevent ADHD. Some studies indicate an association between mothers who smoke during pregancy and a higher rate of ADHD in their children. Avoiding smoking, alcohol, and drugs during pregancy may help prevent a higher risk of developing ADHD or similar behaviour in offspring.
ADHD's studies of gender influences on
attention-deficit/hyperactivity disorder in youth and relatives." ''Psychiatr Clin North Am''. Jun;27(2):225–32. PMID 15063995
Some sources claim to have identified historical and literary references to ADHD before 1900, however, the condition we refer to as "ADHD" dates to the mid-twentieth century, when physicians developed a diagnosis for a set of conditions variously referred to as "minimal brain damage", "learning/behavioural disabilities" or "hyperactivity".
In 493 BC, physician-scientist . or as merely a moral fable to amuse young children and encourage them to behave properly.
In 1902 the English
Pediatrician George Still gave a series of lectures to the
Royal College Of Physicians in England, and described a condition which some have claimed is analogous to ADHD. Still described a group of children with significant behavioral problems, caused, he believed, by an innate hereditary dysfunction and not by poor child rearing or environment.Still GF. "Some abnormal psychical conditions in children: the Goulstonian lectures". ''Lancet'', 1902;1:1008-1012 However, analysis of Still's descriptions by Palmer and Finger indicated that the qualities Still described are not "considered primary symptoms of ADHD".Palmer E, Finger S. 2001. "An Early Description of AD/HD: Dr. Alexander Crichton and ‘Mental Restlessness’". ''Child Psychology and Psychiatry Review'' 6(2):66–73.
The . This caused a significant rift in the understanding of the disorder. Europeans saw hyperkinesis as unusual and often associated it with retardation, brain damage, and conduct disorders, and changes to the ICD were not made until 1994. In the USA by 1966, following observations that the condition existed without any objectively observed pathological disorder or injury, researchers changed the terminology from ''Minimal Brain Damage'' to ''Minimal Brain Dysfunction''.
In 1937 a Dr. Bradley in
Providence, RI reported that a group of children with behavioral problems improved after being treated with stimulant medication. In 1957 the stimulant
Methylphenidate (
Ritalin ) became available. In its various forms (Ritalin, Focalin, Concerta, Metadate, and Methylin), it remains one of the most widely prescribed medications for ADHD. Ritalin was first produced in 1950. Initially the drug was used to treat narcolepsy, chronic fatigue, depression, and to counter the sedating effects of other medications. The drug began to be used for ADHD in the 1960s and steadily rose in use. In 1975
Pemoline (Cylert) was approved by the FDA for use in the treatment of ADHD. While an effective agent for managing the symptoms, the development of liver failure in 14 cases over the next 27 years would result in the manufacturer withdrawing this medication from the market. New delivery systems for medications were invented in 1999 that eliminated the need for multiple doses across the day or taking medication at school. These new systems include pellets of medication coated with various time-release substances to permit medications to dissolve hourly across an 8–12 hour period (Medadate CD, Adderall XR, Focalin XR) and an osmotic pump that extrudes a liquid methylphenidate sludge across an 8–12 hour period after ingestion (Concerta). In 2003 –
Atomoxetine (Strattera) received the first FDA approval for a nonstimulant drug to be used specifically for ADHD. In 2007
Lisdexamfetamine becomes the first
Prodrug to receive FDA approval for ADHD. The landmark study of 1999 – The largest study of treatment for ADHD in history – is published in the ''
American Journal Of Psychiatry ''. Known as the ''Multimodal Treatment Study of ADHD'' (MTA Study), it involved more than 570 children with ADHD at 6 sites in the United States and Canada randomly assigned to 4
Treatment Groups . Results generally showed that medication alone was more effective than psychosocial treatments alone, but that their combination was beneficial for some subsets of ADHD children beyond the improvement achieved only by medication. More than 40 studies have subsequently been published from this massive dataset.
Psychiatry first codified a condition called “hyperkinetic reaction of childhood” in 1968, displaying the psychoanalytical influences of that time. The name ''Attention Deficit Disorder'' (ADD) was first introduced in DSM-III, the 1980 edition. By 1987 – The DSM-IIIR was released changing the diagnosis to "Undifferentiated Attention Deficit Disorder." Further revisions to the DSM were made in 1994 – in attention-deficit hyperactivity disorder". ''Archives of General Psychiatry'', 53, 607–616. PMID 14765004
See Also: Controversy about ADHD
The ADHD diagnosis has been questioned on many fronts. Some critics focus upon the positive traits that people with ADHD are thought to have, such as "
Hyperfocus ing." Others believe ADHD is a divergent or normal-variant human behavior (using the term ''
Neurodiversity '' to describe this idea), emphasizing that human behaviour is immensely variable and "ADHD" may simply represent one part of the spectrum.
Special Education and the Concept of Neurodiversity New Horizons for Learning. Such critics sometimes allege that ADHD is not actually a discrete condition and question why it should be treated with drugs. Others dispute the alleged genetic basis of ADHD.
- A special issue of the journal ''Clinical Psychology Review'' focuses on ADHD. Includes such articles as ''Neuropsychological functioning in people with ADHD across the lifespan'' by L. Seidman, ''Evidence-based psychosocial treatments for children and adolescents with ADHD'' by A. Chronis, H. Jones and V. Raggi, et al.
- Barkley, Russell A. ''Take Charge of ADHD: The Complete Authoritative Guide for Parents'' (2005) New York: Guilford Publications.
- Bellak L, Kay SR, Opler LA. (1987) "Attention deficit disorder psychosis as a diagnostic category". ''Psychiatric Developments'', 5 (3), 239-63. PMID 3454965
- Carey,Benedict Debate Over Children and Psychiatric Drugs
- Conrad, Peter ''Identifying Hyperactive Children'' (Ashgate, 2006).
- Green, Christopher, Kit Chee, ''Understanding ADD''; Doubleday 1994; ISBN 0-86824-587-9
- Hanna, Mohab. (2006) ''Making the Connection: A Parent's Guide to Medication in AD/HD'', Washington D.C.: Ladner-Drysdale.
- Joseph, J. (2000). "Not in Their Genes: A Critical View of the Genetics of Attention-Deficit Hyperactivity Disorder", ''Developmental Review'' 20, 539-567.
- Kelly, Kate, Peggy Ramundo. (1993) ''You Mean I'm Not Lazy, Stupid or Crazy?! A Self-Help Book for Adults with Attention deficit Disorder''. ISBN 0-684-81531-1
- Matlen, Terry. (2005) "Survival Tips for Women with AD/HD". ISBN 1886941599
- Ninivaggi, F.J. "Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Rethinking Diagnosis and Treatment Implications for Complicated Cases", ''Connecticut Medicine''. September 1999; Vol. 63, No. 9, 515-521. PMID 10531701
- Timimi, Sami. (2005) ''Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture'' London Palgrave McMillan ISBN 1-4039-4511-X
