|
AN
OVERVIEW OF ADHD
What is ADHD (ADD)?
The official definition
of Attention Deficit Hyperactivity Disorder (ADHD) as it appears
in the Diagnostic and Statistical manual of the American Psychiatric
Association is: ADHD is a disorder that can include a list of nine
specific symptoms of inattention and nine symptoms of hyperactivity/impulsivity.
Individuals with ADHD may know what to do but do not consistently
do what they know because of their inability to efficiently stop
and think prior to responding, regardless of the setting or task.
Characteristics of ADHD have been demonstrated to arise in early
childhood for most individuals. This disorder is marked by chronic
behaviors lasting at least six months with an onset often before
seven years of age. At this time, four subtypes of ADHD have been
defined. These include the following:
1. ADHD - Inattentive
type is defined by an individual experiencing at least six of
the following characteristics: a.
Fails to give close attention to details or makes careless mistakes
b. Difficulty sustaining attention c. Does not appear to listen
d. Struggles to follow through on instructions e. Difficulty with
organization f. Avoids or dislikes requiring sustained mental effort
g. Often loses things necessary for tasks h. Easily distracted i.
Forgetful in daily activities
2. ADHD - hyperactive/impulsive
type is defined by an individual experiencing six of the following
characteristics: a. Fidgets with hands or feet or squirms in seat
b. Difficulty remaining seated c. Runs about or climbs excessively
(in adults may be limited to subjective feelings of restlessness)
d. Difficulty engaging in activities quietly e. Acts as if driven
by a motor f. Talks excessively g. Blurts out answers before questions
have been completed h. Difficulty waiting in turn taking situations
i. Interrupts or intrudes upon others
3. ADHD - combined
type is defined by an individual meeting both sets of attention
and hyperactive/impulsive criteria.
4. ADHD - not otherwise
specified is defined by an individual who demonstrates some
characteristics but an insufficient number of symptoms to reach
a full diagnosis. These symptoms, however, disrupt everyday life.
The majority of adults
with ADHD have been described as experiencing symptoms very similar
to the problems experienced by children. They are often restless,
easily distracted, struggle to sustain attention, are impulsive
and impatient. They have been described as experiencing problems
with stress intolerance leading to greater expressed emotion. Within
the workplace they may not achieve vocational positions or status
commensurate with their siblings or intellectual ability.
Children and adults who
have ADHD exhibit degrees of inattention or hyperactivity/impulsivity
that are abnormal for their ages. This can result in serious social
problems, or impairment, of family relationships, success at school
or work or in other life endeavors.
Children and adults can
exhibit other psychiatric disorders (medically known as comorbidity),
along with their ADHD symptoms. Most commonly, these include oppositional
defiant or conduct disorder, along with or separate from internalizing
disorders, such as anxiety and depression.
Other definitions have
existed, such as that for Attention Deficit disorder, or ADD. These
use different labels for the same conditions and can be interchanged
with ADHD. For the purposes of this fact sheet, however, we will
continue to use ADHD.
Statistics:
About 1% to 3% of the school-aged population has the full ADHD syndrome,
without symptoms of other disorders. Another 5% to 10% of the school-aged
population have a partial ADHD syndrome or one with other problems,
such as anxiety and depression present. Another 15% to 20% of the
school-aged population may show transient, subclinical, or masquerading
behaviors suggestive of ADHD. A diagnosis of ADHD is not warranted
if these behaviors are situational, do not produce impairment at
home and school, or are clearly identified as symptoms of other
disorders. Gender and age affect the ways in which people with ADHD
express their symptoms. Boys are about three times more likely than
girls to have symptoms of ADHD. Symptoms of ADHD decrease with age,
but symptoms of associated features and related disorders increase
with age. Between 30% and 50% of children still manifest symptoms
into adulthood.
Causes:
Experts have investigated genetic and environmental causes for ADHD.
Some children may inherit a biochemical condition, which influences
the expression of ADHD symptoms. Other children may acquire the
condition due to abnormal fetal development, which has subtle effects
on brain regions that control attention and movement. Recently,
scientists have uncovered research based on brain imaging to localize
the brain areas involved in ADHD and have found that areas in the
frontal lobe and basal ganglia are reduced by about 10 percent in
size and activity in ADHD children. Recent research based on genetic
mechanisms has focused on dopamine as the primary neurotransmitter
involved in ADHD. Dopamine pathways in the brain, which link the
basal ganglia and frontal cortex, appear to play a major role in
ADHD. Commonly suspected causes of ADHD have included toxins, developmental
impairments, diet, injury, ineffective parenting and heredity.
How is ADHD diagnosed?
While there is no biological or psychological test that makes a
definitive diagnosis of ADHD, a diagnosis can be made based on one's
clinical history of abnormality and impairment. An evaluation for
ADHD will often include assessment of intellectual, academic, social
and emotional functioning. Medical examination is also important
to rule out low occurring but possible causes of ADHD like symptoms
(e.g., adverse reaction to medications, thyroid problems, etc.).
The diagnostic process must also include gathering data from teachers
as well as other adults who may interact on a routine basis with
the individual being evaluated. It is even more important in the
ADHD adult diagnostic process to obtain a careful history of childhood,
academic, behavioral and vocational problems. With the increased
recognition that ADHD is a disorder presenting throughout the life
span, questionnaires and related diagnostic tools for the assessment
of adult ADHD have been standardized and are increasingly available.
ADHD diagnoses are based on a person having three different symptoms.
The full syndrome is diagnosed when at least nine symptoms from
both sets of subtypes (above) are present. Partial syndromes, which
are predominantly inattentive or hyperactivity/impulsivity subtypes,
are diagnosed when six or more symptoms are present from just one
set.
Treatment:
There are two modalities of treatment that specifically target symptoms
of ADHD. One uses medication and the other is a non-medical treatment
with psychosocial interventions. The combination of these treatments
is called multimodality treatment. Treating ADHD in children requires
a coordinated effort between medical, mental health and educational
professionals in conjunction with parents. This combined set of
treatments offered by a variety of individuals is referred to as
multi-modal intervention. A multi-modal treatment program should
include: . Parent training concerning the nature of ADHD as well
as effective behavior management strategies . An appropriate educational
program . Individual and family counseling, when needed, to minimize
the escalation of family problems . Medication when required Psychostimulants
are the most widely used medications for the management of ADHD
symptoms. At least 70% to 80% of children and adults with ADHD respond
positively to psychostimulant medications. Stimulant medications
have been used to treat the cognitive and behavioral symptoms of
ADHD for more than 50 years. A study by Wilens and Biederman (1997)
summarized the findings of controlled trials validating the use
of these medications. Treatment with stimulants is beneficial in
about 80% of children with ADHD. Behavior modification techniques
have been used to treat the behavioral symptoms of ADHD for more
than a quarter of a century. A summary of the literature on trials
that have validated the efficacy of this approach shows that, in
many cases, behavior modification alone has not been sufficient
to address severe symptoms of ADHD. Classroom success for children
with ADHD often requires a range of interventions. Most children
with ADHD can be taught in the regular classroom with either minor
adjustments in the classroom setting, the addition of support personnel,
and/or special education programs provided outside of the classroom.
The most severely affected children with ADHD often experience a
number of occurring problems and require specialized classrooms.
Laws passed during the last five years have mandated educational
interventions for children with ADHD. Today, modifications and special
placements in public school settings are part of treatment of ADHD.
The coordination of school-based interventions with medical interventions
has become possible (but remains difficult) due to these changes
in educational law regulations.
Research:
Controversial and important areas of ADHD research include investigations
into the definitions of this disorder. These include the validity
of partial syndromes, the need for gender-specific criteria and
age-specific criteria, and the importance of accompanying troublesome
conditions. In the areas of current ADHD statistical research: Epidemiological
investigations of the true prevalence to determine how many children
have the symptoms of ADHD and of administrative prevalence to determine
how many children are recognized and treated are controversial and
important topics. Scientists are also researching the causes of
ADHD by performing investigations of the brain and genetics. Brain
asymmetries and developmental changes in specific anatomical structures
linked to ADHD and a genome scan to confirm and refute multiple
hypothesized genes and to identify unexpected genes linked to ADHD
are also controversial and important research topics in this area
of research on ADHD. Research into the treatment of ADHD is aimed
at developing new pharmacological treatments for ADHD, evaluating
long-term outcomes of multi-modality treatments. Pharmaceutical
companies are developing new medications and longer acting medications.
Prognosis:
Children with ADHD are at risk for school failure, emotional difficulties
and significant, negative adult outcome in comparison to their peers.
However, early identification and treatment has demonstrated that
these children can overcome many of these hurdles and achieve success.
The topic of ADHD probably will continue to be one of the most widely
researched and debated in mental health and child development. The
five-year multi-modal ADHD treatment study underway by the NIMH
will provide many answers to remaining questions regarding the diagnosis,
treatment and outcome of individuals with ADHD. Increasing awareness
in the community of the nature and symptoms of ADHD also offers
encouraging signs of support and understanding for individuals with
ADHD and their families.
Resources
The information in this Fact sheet was summarized from and can be
reviewed in greater depth in the following authoritative sources:
Barkley, R.A. (1990). Attention Deficit Hyperactivity Disorder:
A Handbook for Diagnosis and Treatment. New York, NY; Guilford Press
Barkley, R.A. (in press). Attention Deficit Hyperactivity Disorder:
a Handbook for Diagnosis and Treatment --2nd edition. New York,
NY; Guilford Press Barkley, R.A. (1997). ADHD and the Nature of
Self-Control.New York, NY: Guilford Press DuPaul, G.J. & Stoner,
G. (1994). ADHD in the Schools: Assessment and Intervention Strategies.
New York, NY: Guilford Press. Goldstein, S. (1997). Managing Attention
and Learning Disorders in Late Adolescence and Adulthood: A Guide
for Practitioners. New York, NY: Wiley Interscience Press. Goldstein,
S. & Goldstein, M. (1990). Managing Attention Disorders in Children:
A Guide for Practitioners. New York, NY: Wiley Interscience Press.
Goldstein, S. & Goldstein, M. (in press). Attention Deficit
Hyperactivity Disorder: A Guide for Practitioners. New York, NY:
Wiley Interscience Press. Greenhill, L.L. & Osman, B.B. (1991).
Ritalin, Theory and Patient Management. New York, NY: Mary Ann Liebert,
Inc. Publisher Matson, J.L. (1993). Handbook for Hyperactivity in
Children. Boston, MA: Allyn & Bacon Nadeau, K.G. (1995). A Comprehensive
Guide to Attention Deficit Disorder in Adults. New York, NY: Brunner/Mazel
Publishers.
Credit
CHADD gratefully acknowledges the contribution of James Swanson,
Ph.D., UCI Child Development Center, a member of CHADD's Professional
Advisory Board, and Timothy Wilens, M.D., Associate Professor at
Harvard Medical School, Department of Child Psychology, in the development
of facts and information presented in this overview.
8181 Professional Place, Suite 201, Landover, MD 20785
(800) 233-4050 ---301-306-7070---FAX 301-306-7090
For questions about AD/HD or CHADD, please see the Frequently Asked
Questions
http://www.chadd.org/facts/add_facts01.htm
If you have any questions about learning disabilities, adult attention
deficit disorder, or other disabilities and how they affect learning,
contact
ACCESS (805) 378-1461
Return
to Information for High School Students/Incoming Freshmen
Return
to Information for Faculty
|
