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A.D.H.D.
Attention Deficit Hyperactivity Disorder
Attention deficit hyperactivity disorder (ADHD) is a disorder characterized
by impulsiveness, poor attention span and extreme restlessness. It is
truly a diagnosis of the nineties, which usually results when the press
takes an interest in a particular illness. ADHD has been around for
years, but as new and successful methods of treatment become available,
the press has taken a renewed interest. Research and scientific data
have better defined this condition and determined that it also occurs
in adults.
The diagnosis is being entertained more and more by teachers who tell
the parents to take their child to their physician for possible treatment
of ADHD. There is a tremendous incentive for teachers to get these children
treated. One child in a class of thirty can single-handedly disrupt
and hamper the learning process for the other twenty-nine students.
Also, as the teacher's stress level increases, his or her effectiveness
as a teacher decreases dramatically.
This brings up the problem of over-diagnosis that always should to be
taken into consideration. The child should be thoroughly evaluated before
he or she is given the diagnosis of ADHD. Every misbehaving child does
not have ADHD and will not benefit from medication.
For years, parents have been struggling with the disruptive and difficult
child. As with most behavior problems, there is a tendency for parents
to blame themselves. This condition can wreck a family or result in
extreme disharmony. Now we know that the disruptive, difficult child
has a condition that can frequently be treated with medication.
It is estimated that approximately 3-5% of school-age children meet
the criteria for ADHD. Males are three to six times more likely to have
ADHD. We now believe that it may persist into adulthood in approximately
10% to 50% of individuals.
DIAGNOSIS OF ADHD
Unfortunately, there is no specific lab test or procedure that
can make or even suggest the diagnosis of ADHD. A history from parents
and teachers is usually used to make the diagnosis. There are several
questionnaires that are used to help make the diagnosis of ADHD. Listed
below are some of the most common symptoms of ADHD.
1. Impulsiveness
2. Poor attention span
3. Restlessness
4. Forgetfulness
5. Distractibility
6. Poor attention to detail
7. Difficulty in maintaining attention in school, work or play
8. Talking out of turn
9. Careless mistakes in tasks
10. Loses things
11. Difficulty remaining seated
These symptoms must be present for at least 6 months to qualify for
a diagnosis of ADHD. Some of the symptoms must occur before the age
of 7. The symptoms must be significantly severe as to impair social,
academic or work performance.
Many times these children perform better in unfamiliar situations. The
disorder may not manifest itself for several weeks or months after they
first begin school. After the environment becomes more familiar, they
may manifest symptoms of ADHD. This phenomena would also make it difficult
for a physician to get a good idea of a child's behavior pattern from
a single office visit. It can be quite frustrating for a parent to tell
a physician how difficult her child is to control when the child is
sitting calmly on the exam table. This is why the diagnosis needs to
be made in conjunction with teachers, as well as parents who can provide
an accurate history of the child's behavior. About one in seven children
with ADHD will not have the hyperactive symptom. This usually causes
a delay in the diagnosis of ADHD.
SUGGESTIVE CAUSES OF ADHD
There have been numerous suggested causes of ADHD, but most
of them have not been confirmed by scientific studies. Food additives
and sugar have been a popular suggested cause in the past, but studies
have not substantiated their involvement. Certainly heredity plays an
important part in the cause of ADHD. Presently, the most likely cause
seems to be related to the disruption of neurotransmitters in the brain.
This is probably why the medication works, since the medication is known
to alter the concentration of neurotransmitters in the brain. Like many
"psychological problems," this disorder will also probably
turn out to be a chemical problem with a strong hereditary component.
OTHER DISRUPTIVE CONDITIONS
It is important to consider other conditions when faced with a disruptive
child. Another condition called Oppositional Defiant Disorder has some
symptoms that can be confused with ADHD. Usually there is a recurrent
pattern of negative, hostile and defiant behavior towards authority
figures. Specific behaviors may include frequent arguing, temper outburst,
disobeying rules and blaming others for their own misbehavior.
Conduct Disorder is characterized by a behavior pattern in which the
rights of others and social rules are violated. These children may be
very aggressive to other children and/or animals. They are very destructive
to property and frequently are involved in theft and lying. They have
frequent school truancy and run away from home on a regular basis.
Frequently, children with ADHD will also have Oppositional Defiant Disorder
or a Conduct Disorder that coexist. Learning disabilities are also quite
common in children with ADHD.
EVALUATION
The first person to evaluate a child with ADHD is usually the
child's physician. In some cases the diagnosis is quite obvious and
treatment can be started fairly soon. In other cases the diagnosis may
be much more difficult and extensive testing is warranted.
ADULT ADHD
This condition has recently been introduced into the lay-public
through talk shows and other forms of media such as 60 Minutes. If an
adult has a history of ADHD as a child, then obviously it is easier
to diagnose this condition. Usually, adults read about the symptoms,
or see a television program and realize that they have a lot of the
symptoms. Getting a history of their childhood behavior, particularly
before the age of 7, is extremely difficult, if not impossible to obtain.
It is also quite easy to distort a remote history of an individual's
behavior. The potential for abuse of the medication has to be considered,
but the medicine is not considered addictive under normal circumstances.
TREATMENT
It is important to work closely with the child's teacher. There
should be a strong emphasis on behavioral therapy. Reinforce good behavior.
Make eye contact with each request. Give one task at a time.
The most common medications that are used for ADHD or ADD are stimulants.
Methylphenidate comes is several different forms such as Ritalin, Concerta,
Metadate CD and Ritalin LA. This works about 70-80% of the time. The
response to the medication is usually within a few hours of the first
dose. The dose may need to be adjusted upward, depending on the child's
response. Adderall is also used but the safety has recently been questioned.
Strattera is also used and is not a stimulant or controlled medication
but the safety of this medication has also been questioned. Antidepressants
such as imipramine, Wellbutin and desipramine are frequently used and
are occasionally helpful. If a coexisting depression exists then the
antidepressants would be the treatment of choice. Clonidine has also
been helpful in some individuals. This is a medicine that is also used
for hypertension.
Families seeking more information should contact The national office
of the organization called Children and Adolescents with Attention Deficit
Disorders (CHADD), 8181 Professional Pl. Suite 201, Landover, MD 20785;
800-233-9273.
REFERENCES
1. Searight HR, et al. Attention-Deficit/Hyperactivity Disorder:
Assessment, Diagnosis, and Management. J. Fam Practice Vol. 40, No.
3(Mar), 1995.
2. American Psychiatric Association. Diagnosis and Statistical Manual
of Mental Disorders. 4th ed. Washington, DC American Psychiatric Association,
1994.
3. Wiedermann BL, et al. Acne. Griffith' 5 Minute Clinical Consult.
2004, Electronic version 4.0.139.
The information provided above is offered as a community service about
health-care issues and is not a substitute for individual consultation.
Advice on individual problems should be obtained from your personal
physician. This information is based on research by the author and represents
his interpretation of the literature.
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Readers may send questions to our
email address. This column is for informational purposes only and
is not a substitute for professional or medical advice.
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