Attention Deficit Disorder
I was not diagnosed with ADD until
I was 30 years old. The diagnosis actually brought me relief because
I felt like a failure up until that point. After all, why couldn't
I just pull myself together and concentrate enough to do the things I wanted
to do? I had assumed that I lacked the discipline and willingness
needed to get ahead in life. Once I started on medication, my life
changed drastically for the better. I could concentrate better and
I began to get things done. Now it is not nearly as hard for me to
keep focused on what I'm doing. There is more information below from
the NAMI (National Alliance for the Mentally
Ill) fact sheet about
AD(H)D.
What is ADD? Is it different than
ADHD?
This is a question that has become
increasingly difficult to answer simply. ADHD, or attention-deficit/hyperactivity
disorder, is the only clinically diagnosed term for disorders characterized
by inattention, hyperactivity, and impulsivity used in the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental Disorder, Fourth
Edition, the diagnostic "bible" of psychiatry. However (and this is where
things get tricky), ADD, or attention-deficit disorder, is a term that
has become increasingly popular among laypersons, the media, and even some
professionals. Some use the term ADD as an umbrella term-after all, ADHD
is an attention-deficit disorder. Others use the term ADD to refer to the
predominantly inattentive type of ADHD, since that type does not feature
hyperactive symptoms. Lastly, some simply use the terms ADD and ADHD interchangeably.
The bottom line is that when people speak of ADD or ADHD, they generally
mean the same thing. However, only ADHD is the "official" term.
Attention-deficit/hyperactivity
disorder (ADHD) is an illness characterized by inattention, hyperactivity,
and impulsivity. The most commonly diagnosed behavior disorder in young
persons, ADHD affects an estimated three percent to five percent of school-age
children.
Although ADHD is usually diagnosed
in childhood, it is not a disorder limited to children-ADHD often persists
into adolescence and adulthood and is frequently not diagnosed until later
years.
What are the symptoms of ADHD?
There are actually three different
types of ADHD, each with different symptoms: predominantly inattentive,
predominantly hyperactive/impulsive, and combined.
(1) Those with the predominantly
inattentive type often:
-
fail to pay close attention to
details or make careless mistakes in schoolwork, work, or other activities
-
have difficulty sustaining attention
to tasks or leisure activities
-
do not seem to listen when spoken
to directly
-
do not follow through on instructions
and fail to finish schoolwork, chores, or duties in the workplace
-
have difficulty organizing tasks
and activities
-
avoid, dislike, or are reluctant
to engage in tasks that require sustained mental effort
-
lose things necessary for tasks
or activities
-
are easily distracted by extraneous
stimuli
-
are forgetful in daily activities
(2) Those with the predominantly
hyperactive/impulsive type often:
-
fidget with their hands or feet
or squirm in their seat
-
leave their seat in situations
in which remaining seated is expected
-
move excessively or feel restless
during situations in which such behavior is inappropriate
-
have difficulty engaging in leisure
activities quietly
-
are "on the go" or act as if "driven
by a motor"
-
talk excessively
-
blurt out answers before questions
have been completed
-
have difficulty awaiting their
turn
-
interrupt or intrude on others
(3) Those with the combined type,
the most common type of ADHD, have a combination of the inattentive and
hyperactive/impulsive symptoms.
What is needed to make a diagnosis
of ADHD?
A diagnosis of ADHD is made when
an individual displays at least six symptoms from either of the above lists,
with some symptoms having started before age seven. Clear impairment in
at least two settings, such as home and school or work, must also exist.
Additionally, there must be clear evidence of clinically significant impairment
in social, academic, or occupational functioning.
How common is ADHD?
ADHD affects an estimated two
million American children, an average of at least one child in every U.S.
classroom. In general, boys with ADHD have been shown to outnumber girls
with the disorder by a rate of about three to one. The combined type of
ADHD is the most common in elementary school-aged boys; the predominantly
inattentive type is found more often in adolescent girls.
While there is no specific data
on the rates of ADHD in adults, the disorder is sometimes not diagnosed
until adolescence or adulthood, and half of the children with ADHD retain
symptoms of the disorder throughout their adult lives. (It is generally
believed that older individuals diagnosed with ADHD have had elements of
the disorder since childhood.)
Is ADHD associated with other disorders?
Yes. In fact, symptoms like those
of ADHD are often mistaken for or found occuring with other neurological,
biological, and behavioral disorders. Nearly half of all children with
ADHD (especially boys) tend to also have oppositional defiant disorder,
characterized by negative, hostile, and defiant behavior. Conduct disorder
(marked by aggression towards people and animals, destruction of property,
deceitfulness or theft, and serious rule-breaking) is found to co-occur
in an estimated 40 percent of children with ADHD. Approximately one-fourth
of children with ADHD (mostly younger children and boys) also experience
anxiety and depression. And, at least 25 percent of children with ADHD
suffer from some type of communication/learning disability. There is additionally
a correlation between Tourette's syndrome, a neurobiological disorder characterized
by motor and vocal tics, and ADHD-only a small percentage of those with
ADHD also have Tourette's, but at least half of those with Tourette's also
have ADHD. Research is also beginning to show that ADHD-like symptoms are
sometimes actually manifestations of childhood-onset bipolar disorder.
What causes ADHD?
First of all, it is important
to realize that ADHD is not caused by dysfunctional parenting, and those
with ADHD do not merely lack intelligence or discipline.
Strong scientific evidence supports
the conclusion that ADHD is a biologically based disorder. Recently, National
Institute of Mental Health researchers using PET scans have observed significantly
lower metabolic activity in regions of the brain controlling attention,
social judgment, and movement in those with ADHD than in those without
the disorder. Biological studies also suggest that children with ADHD may
have lower levels of the neurotransmitter dopamine in critical regions
of the brain.
Other theories suggest that cigarette,
alcohol, and drug use during pregnancy or exposure to environmental toxins
such as lead may be linked to the development of ADHD. Research also suggests
a genetic basis to ADHD-the disorder tends to run in families.
While early theories suggested
that ADHD may be caused by minor head injuries or brain damage resulting
from infections or complications at birth, research found this hypothesis
to lack substantial supportive evidence. Furthermore, scientific studies
have not verified dietary factors, another widely discussed possible influence
for the development of ADHD, as a main cause of the disorder.
How can ADHD be treated?
Many treatments-some with good
scientific basis, some without-have been recommended for individuals with
ADHD. The most proven treatments are medication and behavioral therapy.
Medication
Stimulants are the most widely
used drugs for treating attention-deficit/ hyperactivity disorder. The
four most commonly used stimulants are methylphenidate (Ritalin), dextroamphetamine
(Dexedrine, Desoxyn), amphetamine and dextroamphetamine (Adderall), and
pemoline (Cylert). These drugs increase activity in parts of the brain
that are underactive in those with ADHD, improving attention and reducing
impulsiveness, hyperactivity, and/or aggressive behavior. Antidepressants,
major tranquilizers, and the antihypertensive clonidine (Catapres) have
also proven helpful in some cases.
Every person reacts to treatment
differently, so it is important to work closely and communicate openly
with your physician. Some common side effects of stimulant medications
include weight loss, decreased appetite, trouble sleeping, and, in children,
a temporary slowness in growth; however, these reactions can often be controlled
by dosage adjustments. Medication has proven effective in the short-term
treatment of more than 76 percent of individuals with ADHD.
Behavioral Therapy
Treatment strategies such as rewarding
positive behavior changes and communicating clear expectations of those
with ADHD have also proven effective. Additionally, it is extremely important
for family members and teachers or employers to remain patient and understanding.
Children with ADHD can additionally
benefit from caregivers paying close attention to their progress, adapting
classroom environments to accommodate their needs, and using positive reinforcers.
Where appropriate, parents should work with the school district to plan
an individualized education program (IEP).
Other Treatments
There are a variety of other treatment
options offered (some rather dubious) for those with ADHD. Those treatments
not proven to work scientifically include biofeedback, special diets, allergy
treatment, megavitamins, chiropractic adjustment, and special-colored glasses.