Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder

A youngster who doesn’t pay attention in class, who can’t sit still, is frequently loud and disruptive, feisty on the playground, and repeatedly gets into trouble, may be struggling with a behavioral condition known as Attention Deficit Disorder (ADD) or more recently Attention Deficit Hyperactivity Disorder (ADHD).  It is a highly treatable condition that responds well to certain medications and behavioral management.  Left untreated, it can cause unwanted educational, job, career, and social problems.  Although wide gaps still exist in our knowledge and understanding of ADHD, recent research points toward it having a biological basis…caused by a chemical imbalance in the part of the brain associated with paying attention, impulse control and activity level.  It appears a large percentage of ADHD can be genetically linked, though some physical circumstances, e.g. brain damage, and health conditions can also be precipitating factors.  It is important to recognize that persons with ADHD usually have normal to above average intelligence, are often very creative, and usually exhibit high energy levels.

Though it’s possible for ADHD to be diagnosed as early as ages 2-3, it usually shows up when a youngster becomes involved in the more complex social interactions associated with starting to school.  According to some estimates, 3%-5% of school age children are affected.  Other estimates run as high as 20%.  Three times as many boys are diagnosed with the disorder as girls.  One explanation for this disparity is that girls are most affected by not paying attention, whereas the boys are most likely to demonstrate more aggressive, disruptive behavior patterns that gain the attention of family members and teachers.  Many children appear to outgrow the problem, but it’s now known that for some the condition continues on through adolescence into adulthood.

Some of the more recognizable symptoms are poor attention, poor concentration, poor impulse control, being easily distracted, being fidgety, and becoming disruptive or getting “carried away” in play situations.  Families of persons with ADHD may be more susceptible to conflict and increased levels of stress.  Adults with the disorder often have difficulties with employment and interpersonal relationships and frequently have other health problems or secondary conditions that compound their situation.

To date there is no known independent diagnostic test for ADHD. To find out if a person has ADHD it is imperative to have the disorder diagnosed by a knowledgeable professional.  This is important to rule out other medical conditions that may have similar symptoms.  ADHD can be misdiagnosed when it is mistaken for youthful exuberance and excitement or plain old misbehavior.

There is currently no cure for ADHD.  Treatment with medication such as central nervous system (CNS) stimulants has been used for years.  It’s thought that these drugs improve the chemical imbalance in the brain that’s responsible for the disorder and allows the brain to function normally while the medication is working.  Some recent research supports this conclusion.

The most frequently used CNS stimulant drug is methylphenidate (Ritalin®).  There has been some controversy over its use, and other stimulant drugs, to treat ADHD.  The FDA classifies these drugs as having abuse potential.  One side believes their use can lead to their abuse as well as other drugs and alcohol.  The other side considers any abusive/experimental use of drugs to be prompted by the nature of the disorder itself…the natural tendency toward impulsive, risk–taking behavior...and not the drugs.  There are no long-term studies (longer than one year) to support either allegation.  No conclusive evidence has surfaced that the careful therapeutic use of CNS stimulants is harmful.

Another method of treatment is behavior modification.  Both psychotherapy and pharmacotherapy have their proponents.  There seems to be no substantive benefit from combining the two treatments.  There is indication of some improvement in social behavior that is greatly appreciated by both teachers and family.  One other reason for considering treatment with both methods is the possibility of reducing the drug dosage.  Some limited research suggests this may be true, but again this is not supported by long-term studies.

Additional information about ADD/ADHD is available on the internet.  Some suggested sites:

            www.chadd.org                                             www.add.org
            www.mentalhealth.com                                 www.onhealth.webmd.com
            www.nih.gov/publicat/helpchild.cfm              www.nih.gov/publicat/adhdqa.cfm

January 2001

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