ATTENTION DEFICIT HYPERACTIVITY DISORDER
"An estimated 3 to 5% of Americans suffer from
ADHD. About 50% of persons who need medications as children still need them as
adults. (Source: NIMH)."
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Attention Deficit Hyperactivity Disorder (ADHD) is a very real brain disorder. The
National Institutes for Mental Health estimate that 3 to 5% of Americans suffer from it,
although some studies indicate the rate may be much higher. Boys with ADHD outnumber girls 4
to 1. About 80% of children who need medication for ADHD still need it as teenagers, &
about 50% as adults.
An estimated 3 to 5 % of Americans suffer from ADHD. About 50% of persons who need
medications as children still need them as adults. (Source: NIMH) With proper evaluation and
treatment, children with ADHD have a good chance of succeeding at home and school and of
thriving as adults. Without treatment, many experience peer rejection, school failure or
expulsion, engage in disruptive, antisocial, or criminal behavior, and have higher rates of
physical injuries & substance abuse. In contrast, successfully-treated children do not
have these increased risks.
There is a myth that treatment with stimulants, often the first medication of choice,
will put a child at greater risk of substance abuse as a teenager. But research shows that
it is failure to treat ADHD that puts children at higher risk of substance abuse and school
and social failure.
What causes ADHD?
Research strongly suggests that what we call "ADHD" is a set of related brain
disorders that impair a person's ability to maintain adequate control over attention and
impulses. It appears to have a significant genetic component. Complicating the picture are
psychological and social factors, such as a child with ADHD experiencing serious family
problems or receiving a poor education.
Diagnosis
Diagnosis depends on a medical examination of the patient and use of well-tested diagnostic
methods by a skilled professional gathering comprehensive social, psychological, and medical
data from the patient, family, and teacher (s). It is equally important for the diagnostician
to be familiar with the normal range of behaviors of children of different ages. For
example, a toddler who is a little more energetic than average, does not have - and should
not be treated for - ADHD.
Rating scales are commonly used to assess the degree of inattention, impulsivity, and
hyperactivity (there is no x-ray or laboratory test to diagnose it). The diagnosis is made
in accordance with the standard reference for the diagnosis of mental disorders, the
American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV).
Diagnostic criteria for ADHD in DSM-IV are very specific and are as follows:
- 6 or more symptoms, that persist for at least 6 months, of either inattention
(careless mistakes, ignores details, can't pay attention, doesn't complete chores, loses
things frequently, easily distracted, forgetful) or hyperactivity/ impulsivity
(fidgeting, squirming, cannot sit still, runs or climbs excessively, difficulty playing
quietly or waiting turns, excessive talking, blurting out answers before questions are
completed, interrupts)
- clear evidence of clinically significant impairment
- impairment in at least 2 settings (home, work, school, social)
- some symptoms present prior to age 7
- not caused by other listed mental disorders.
There are 3 major categories. Persons with "ADHD, predominantly inattentive
type" mainly have problems paying attention and are easily distracted. Those with
"ADHD, predominantly hyperactive type" are overactive, fidgety and impulsive. Many
have both problems, which is "ADHD, combined type."
It is essential that the professional evaluating the child be able to distinguish between
ADHD and other causes of inattention, impulsivity and hyperactivity, such as metabolic
disorders, neurologic disorders, childhood depression, bipolar disorder, learning disorders,
and anxiety disorders, and be able to diagnose co-existing illnesses. Sometimes, as in the
case of childhood bipolar disorder, this is challenging.
"Overdiagnosis" refers to children being diagnosed with ADHD when they do not
have it. This can occur when an incomplete evaluation takes place, either because the
clinician is not fully trained or because he/she is not allowed adequate time to do a
complete assessment, often because few health insurers cover this, and because special
education does not have a funded category for ADHD. To complicate matters, when a child is
highly disruptive at home or in the classroom, the parents or teacher may put pressure on
the physician to "fix the problem" by making a diagnosis of ADHD and prescribing
medication.
Even as we recognize that ADHD is over diagnosed, the under diagnosis - children having
ADHD but not being diagnosed and treated - is actually much more common. This is due to a
number of barriers such as lack of information about the symptoms and causes of ADHD, the
stigma of mental illness, the myth that mental illness does not exist, and misperception of
the child's behavior as intentional and willful. The symptoms of ADHD - hyperactivity,
inattention and impulsive behavior - can profoundly interfere with a child's ability to
learn, to make and keep friends, and to feel good about himself. Yet thousands of these
children are never seen by an appropriate professional for evaluation.
Treatment of ADHD
Treatment of ADHD is "multimodal," that is, different interventions are used
simultaneously. A recent large study demonstrated that the key to treatment is medicine
managed by expert physicians - usually child psychiatrists, behavioral pediatricians, or
child neurologists. Psychological, educational, and social interventions, such as educating
the child and family about ADHD and teaching children to monitor their own behavior and
think before they act, are also important, but are seldom fully effective on their own.
Coexisting difficulties such as learning disorders, are often present and should also be
addressed.
The most common group of medications used to treat ADHD, stimulants, are effective for
the large majority of children. They are among the most studied group of children's
medications in the world. Several other medications, such as bupropion (Wellbutrin), are
also used to treat the disorder.
Useful web sites:
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