Attention Deficit Hyperactivity Disorder ADHD is the term for this disorder and has replaced ADD as well. This illness is characterized by inattention, hyperactivity, and impulsivity. This is the most commonly diagnosed behavior disorder in young persons, ADHD affects an estimated 3% to 5% of school age children. ADHD is grounded in an imbalance of the neurotransmitters in the brain and is much more than a young person with energy or an undisciplined mind or life.
Although ADHD is usually diagnosed in childhood, it is not limited to children; ADHD often persists into adolescence and adulthood and is frequently not diagnosed until later years.
Symptoms of ADHD – Attention Deficit Disorder
There are actually three different types of ADHD, each with different symptoms: predominantly inattentive, predominantly hyperactive/impulsive and combined.
Predominantly Inattentive Type:
- 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 from doing the task at hand and sometimes mistaken with poor hearing
- Are forgetful in daily activities and disorganized inability to learn due to a “clouded mind”
Predominantly Hyperactive/Impulsive Type:
- Fidget with their hands or feet or squirm in their seat, ants in their pants
- 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
- Always on the go
- Talk excessively – tough to get a word in edgewise
- Blurt out answers complete your sentences for you
- Have difficulty awaiting their turn
- Interrupt or intrude on others
Those with the combined type, the most common type of ADHD, have a combination of the inattentive and hyperactive/impulsive symptoms.
A diagnosis of ADHD is made when an individual displays at least 6 symptoms from either of the above lists with some symptoms having started before the age of 7. 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. Patients will often say that their inability to learn in class was almost as if they couldn’t hear the teacher or they felt as though they were in the clouds.
What is ADD and is it Different than ADHD
This is a question that has become increasingly difficult to answer. ADHD, or attention-deficit/hyperactivity disorder is the only clinical 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 DSMIV. 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. ADHD is often associated or is comorbid with anxiety.
- Oppositional defiant disorder: 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: 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% of children with ADHD
- Anxiety and depression: Approximately one-fourth of children with ADHD (mostly younger children and boys) also experience anxiety and depression
- Communication/learning disability: At least 25% of children with ADHD have some type of communication/learning disability
- Tourette’s syndrome: There is additionally a correlation between Tourette’s syndrome, a neuro-biological disorder characterized by motor and vocal tics and ADHD. A small percentage of those with ADHD also have Tourette’s, but at least half of those with Tourette’s also have ADHD.
- Bipolar disorder: Research is also beginning to show that ADHD-like symptoms are sometimes manifestations of childhood-onset bipolar disorder.
Possible Causes of ADHD
- Biological basis: 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
- Toxins: Other theories suggest that cigarette, alcohol and drug use during pregnancy or exposure to environmental toxins such as lead may be linked to the causes of ADHD
- Genetic basis: Research also suggests that ADHD is a genetic disorder and tends to run in families. In addition, research has shown that certain forms of genes related to the dopamine neurotransmitter system are linked to increased likelihood of the disorder. There is new genetic data which shows that prenatal stressors can actually change the genes of the fetus and therefore provide the genetic basis for many mental illnesses. The good news is that other studies have shown that genetic engineering is making strides in identifying and manipulating these genes, thus giving us hope for a cure from ADHD someday
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.
Treatment for ADHD
Medications mentioned in this section
Amphetamine and dextroamphetamine
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 – ADHD
Stimulants are the most often used drugs for treating ADHD. Examples of the most commonly used stimulants are methylphenidate (Ritalin), dextroamphetamine (Dexedrine, Desoxyn), amphetamine and dextroamphetamine (Adderall). Some of the stimulant class of medications come in longer acting preparations and can be given once a day. These drugs increase activity in parts of the brain that are under active in those with ADHD, improving attention and reducing impulsiveness, hyperactivity and aggressive behavior. Stimulants have been shown to have the potential for abuse and are classified as controlled substances. The FDA has also approved a non-stimulant medication, Atomoxetine (Straterra), which does not appear to have the same risk of abuse as the stimulants. However, this medication carries a warning that in a small percentage of cases, suicidal thinking can be activated by this medication.
Other medications can be prescribed for ADHD but are done so “off label” which means the FDA has not approved the medication for this particular use in children and adolescents. If the doctor is making that recommendation, ask him or her why and what research and clinical experience warrant such a recommendation. You may get a second opinion from another doctor if you are not satisfied with the answers.
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. There’s controversy about a serious possible heart complication that can occur in a small percent of people who take stimulants. Tics or involuntary movement problems, are not common but can be uncomfortable side effects. It is important to weigh the risks and benefits of these treatments with your doctor. Medication has proven effective in the short-term treatment of about three quarters of individuals with ADHD.
Behavioral Therapy – ADHD
Treatment strategies such as rewarding positive behavior and communicating clear expectations to those with ADHD have also proven effective. Additionally it is extremely important for family members and teachers or employers to remain patient and understanding. Coaching and teaching individuals to live by a schedule and daily planner is quite helpful; without setting goals that are unattainable. I hope this answers the question what is ADHD? If not please read more of the many articles of interest on this subject on this site. Read more about what is ADHD