WHAT IS ATTENTION DEFICIT HYPERACTIVITY DISORDER? | HOW COMMON IS ADHD? | WHAT CAUSES ADHD? | WHAT ARE THE SYMPTOMS OF ADHD? | DO SYMPTOMS CHANGE WITH DEVELOPMENT? | HOW IS ADHD DIAGNOSED? | WHAT ARE THE TREATMENTS FOR ADHD? | WHERE CAN I GET HELP FOR MY CLIENTS?
Attention Deficit Hyperactivity Disorder (ADHD) is a psychiatric disorder characterized by two kinds of symptoms: inattention and hyperactivity-impulsivity. Although these symptoms often occur together, one may be present without the other. Difficulties paying attention often become apparent when a child enters elementary school. At that time, children with ADHD may experience difficulty paying attention or finishing their schoolwork. They may procrastinate or make careless mistakes on their homework.
Inattention tends to persist throughout childhood and adolescence into adulthood, whereas the symptoms of hyperactivity and impulsivity tend to diminish with age. Many children with ADHD develop learning difficulties or other disruptive behaviors.
Over the past twenty years the diagnosis of ADHD has become much more common, partly owing to greater awareness of developmental issues facing young children. ADHD is now the most commonly diagnosed disorder of childhood, affecting three to five percent of school-age children, and occurring three times more often in boys than in girls. On average, about one child in every classroom in the United States has ADHD.
The exact cause of ADHD is unknown, although family history, genes, and biology appear to play important roles. Research shows that ADHD tends to run in families. Between 10 and 35 percent of children with ADHD have a relative who current has ADHD or had it in the past. Approximately one-half of parents who had ADHD as children have a child with the disorder. Research also suggests that ADHD may have genetic causes: when one twin of an identical twin pair has the disorder, the other is likely to have it too. The fact that symptoms of ADHD respond well to treatment with stimulants -- which increase the availability of certain biochemicals in the brain -- suggests that biology may also play a role in the development and maintenance of ADHD.
The primary symptoms of ADHD are:
· Inattention - Difficulty focusing, organizing, and completing routine tasks.
· Hyperactivity - Restlessness and difficulty sitting still.
· Impulsivity - Difficulty curbing immediate reactions, awaiting turn, interrupting or intruding on others.
Although ADHD can be diagnosed at virtually any age, different expressions of the disorder are associated with different ages.
Between the ages of three to five years it is sometimes difficult to differentiate between a youngster with ADHD and a normal active child. Children with ADHD can be distinguished from their peers by their extreme motor restlessness, insatiable curiosity, overly vigorous play, low levels of compliance, difficulty sleeping, and delays in language development.
Most children with ADHD are diagnosed between the ages of 6 to 12 years. Children are faced with the increased demands of school, a more active and demanding schedule, and increased demands to sit still for long periods of time. Teachers and parents often report that ADHD children are easily distracted, restless, impulsive, unable to sustain attention, and that they often `clown around' in class.
Hyperactivity usually diminishes during adolescence, although distractibility and impulsivity may persist. Adolescents with ADHD may perform poorly in school, have low self-esteem, and be at greater risk for drug and alcohol abuse, family conflicts, and depression than their peers.
The diagnosis of ADHD is made by a licensed psychiatrist, physician, psychologist, or social worker who conducts a thorough diagnostic interview with the child and parents. ADHD symptoms may not manifest themselves in structured settings such as a clinician's office, so the clinician must gather information regarding the client's behavior at home, school or work, and other social settings. Because symptoms must persist for at least 6 months before a diagnosis can be made, the clinician obtains a history of the development of ADHD. Psychologists often obtain information on the client's behavior through the use of behavioral rating scales that are completed by teachers, parents, and others who have on-going contact with the child. Interactive, computer-administered tasks called continuous performance tests are also useful tools to help diagnose ADHD.
The principle treatments for ADHD are medication, psychosocial treatment, or a combination of the two.
The most effective medications used to treat ADHD are stimulants, which include methylphenidate (Ritalin) and amphetamines (Dexedrine, Dextrostat, and Adderall). Stimulants relieve symptoms in 75 to 90 percent of children with ADHD. Stimulant medications are metabolized quickly, so administration is timed to meet the child's school schedule and to help the child pay attention and meet academic demands. Antidepressant medications may also be used when children show poor response to stimulants or when they experience unacceptable side effects from stimulants. Tricyclic antidepressants (e.g., imipramine, amitriptyline) have also shown to reduce symptoms in 60-70% of children with ADHD.
Concerns have been raised that children, particularly active boys, are being over-diagnosed with ADHD and thus are receiving medications unnecessarily. However, recent research has found little evidence for the over-diagnosis of ADHD or for the over-prescription of stimulant medications. Most researchers believe that the increased use of stimulants reflects better diagnosis and more effective treatment of the disorder.
Because stimulants are also drugs of abuse and because children with ADHD are at increased risk for substance abuse disorders, concerns have also been raised about the potential for abuse of stimulants by children taking the medication or about the diversion of stimulant medications to others. While stimulants clearly have abuse potential, the rate of lifetime non-medical methylphenidate use has not significantly increased since methylphenidate was introduced as a treatment for ADHD, suggesting that abuse is not a major problem.
Psychosocial treatments can be useful for the individual who (a) does not respond to medication or responds partially, (b) cannot tolerate medication, or (c) expresses a strong preference not to use medication. Even children who are receiving medication may continue to display ADHD symptoms or may exhibit symptoms of other disorders that would benefit from psychosocial treatments. Furthermore, children with ADHD put significant stress on the family. Skills training for parents can help reduce this stress on parents and siblings. The most effective kinds of psychosocial treatments are cognitive-behavioral therapy, psychoeducation, and school-based interventions.
Cognitive-behavioral Therapy. Cognitive-behavioral therapy is a short-term treatment (usually less than 16 sessions) that helps the child and parents work on managing the behaviors and problems associated with ADHD. Cognitive-behavioral therapy usually includes social skills training, which teaches the child appropriate behaviors such as waiting for a turn, asking for help, or responding to teasing, then gives children a chance to practice. For example, a child might learn to "read" other people's facial expressions and tone of voice, in order to respond appropriately.
Cognitive-behavioral therapy also involves parent training, which teaches parents tools and techniques for managing their child's behavior. For example, parents learn how to modify their child's behavior through a system of rewards and penalties. The parents identify a few desirable behaviors that they want to encourage in the child, such as asking for a toy instead of grabbing it, or completing a simple task. The child is told exactly what is expected in order to earn the reward. The child receives the reward when he performs the desired behavior and a mild penalty when he doesn't. Parents may also learn to use stress management methods, such as meditation, relaxation techniques, and exercise to increase their own tolerance for frustration, so that they can respond more calmly to their child's behavior.
School-based Interventions. There are numerous strategies that can be utilized in the schools to maximize a child's ability to function and learn. Some of these strategies include placing the child in the front of the classroom or in a special study carrel to reduce distractions, providing one-on-one instruction, and teaching the most difficult work early in the day or just after the child has taken medication
A recent large-scale study conducted by the National Institute of Mental Health found that medication combined with cognitive-behavioral treatment was no more effective than medication alone in alleviating the primary symptoms of ADHD. However, the addition of cognitive-behavioral treatment to medication did improve functioning in other areas, such as academic performance, oppositional behavior, parent-child relations, and social skills. In addition, combined treatment allowed children to be successfully treated over the course of the study with somewhat lower doses of medication, compared to the medication-only group.
When primary physicians diagnose and treat ADHD, they are more likely than psychiatrists or other clinicians to conclude that an individual doesn't have ADHD when that person fails to respond to medication. Further, primary care physicians are less likely to diagnose other psychiatric disorders that co-occur with ADHD, and they may be less likely to recommend psychosocial interventions. Pediatricians, family practitioners, and psychiatrists are less likely to obtain information from teachers, thus increasing the possibility of misdiagnosis.
Systems of care are often not well-integrated. It may be difficult to coordinate the child's treatment in different settings such as home and school. School-based clinics with a team approach that includes parents, teachers, school psychologists, and other mental health specialists can help coordinate treatment. Lack of insurance coverage for school consultation, parent management training, and other specialized programs also presents a barrier to effective diagnosis and treatment of ADHD.
There are numerous resources for information concerning the diagnosis and treatment of ADHD. In seeking help, persons may be directed to physicians, mental health specialists, community mental health agencies, the psychiatric department of hospitals or clinics, employee assistance programs, health maintenance organizations, university or medical school-affiliated programs, state hospital outpatient clinics, family service or social service agencies, private clinics, self-help groups, pastoral care providers, school counselors, or the local Mental Health Association.
The National Institute of Mental Health (NIMH) provides information on the treatment of children with ADHD and other psychiatric disorders. They can be contacted at:
National Institute of Mental Health
Office of Communications and Public Liaison
Information Resources and Inquiries Branch
6001 Executive Boulevard, Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
(301) 443-4513
nimhinfo@nih. gov.
Additional information about ADHD can also be obtained from:
American Academy of Child and Adolescent Psychiatry
3615 Wisconsin Avenue, N.W.
Washington, DC 20016
(202) 96607300
www.aacap.org
American Psychiatric Association
1400 K Street, N.W.
Washington, DC 20005
(202) 682-6000
www.psych.org
American Psychological Association
750 First Street, N.E.
Washington, DC 20002
(202) 336-5500
www.apa.org
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
(800) 950-NAMI (6264)
www.nami.org
National Mental Health Association
1021 Prince Street
Alexandria, VA 22314
(800) 969-NMHA (-6642)
www.nmha.org
Attention Deficit Information Network (Ad-IN)
475 Hillside Avenue
Needham, MA 02194
(781) 455-9895
Provides up-to-date information on current research, regional meetings. Offers aid in finding solutions to practical problems faced by adults and children with an attention disorder.
ADD Warehouse
300 NW 70th Avenue
Plantation, FL 33317
(800) 233-9273
Distributes books, tapes, videos, assessment on attention deficit hyperactivity disorders. A central location for ordering many of the books listed above. Call for catalog.
Children and Adults with Attention Deficit Disorders
(CH.A.D.D.)
499 NW 70th Avenue, Suite 101
Plantation, FL 33317
(800) 233-4050
A major advocate and key information source for people dealing with attention disorders. Sponsors support groups and publishes two newsletters concerning attention disorders for parents and professionals.
1 This report has been adapted from a number of sources, including: Mental Health: A Report to the Surgeon General (2000), National Institute of Health (NIH) Consensus Statements 2000; NIH Research & Treatment (1999), the American Association of Pediatrics Guidelines on Diagnosis and Treatment of ADHD (2000), and Attention Deficit Hyperactivity Disorder (National Institute of Mental Health, 1996).
WHAT IS ATTENTION DEFICIT HYPERACTIVITY DISORDER? | HOW COMMON IS ADHD? | WHAT CAUSES ADHD? | WHAT ARE THE SYMPTOMS OF ADHD? | DO SYMPTOMS CHANGE WITH DEVELOPMENT? | HOW IS ADHD DIAGNOSED? | WHAT ARE THE TREATMENTS FOR ADHD? | WHERE CAN I GET HELP FOR MY CLIENTS?