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The principal characteristics of Attention Hyperacivity Disorder (ADHD) are inattention, hyperactivity, and impulsivity. These symptoms appear early in a child’s life. Because many normal children may have these symptoms, but at a low level, or the symptoms may be caused by another disorder, it is important that the child receive a thorough examination and appropriate diagnosis by a well-qualified professional.
It is a condition that becomes apparent in some children in the preschool and early school years. It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.
ADHD was first described in 1845. There have since been many names for ADHD, including hyperactive child syndrome, hyperkinetic reaction of childhood, minimal brain dysfunction, and attention deficit disorder (with or without hyperactivity). ADHD is the most extensively studied mental disorder of children, with several thousands of peer-reviewed papers in the scientific literature devoted to this topic. For a thorough, 40 page history of ADHD by Russell Barkley.
There have been a number of theories about the etiology of ADHD. While the exact etiology remains unknown, there are increasing studies showing underactivity in certain parts of the brain, neurotransmitter deficits, genetics, and perinatal complications. MRI, SPECT, and PET scan studies reflect brain functioning that is different than brains without ADHD. It tends to run in families. Between 10 and 35 percent of children with ADHD have a first-degree relative with past or present ADHD. Approximately one-half of parents who had ADHD have a child with the disorder.
If there are questions about the possibility of ADHD, the first step is to begin the evaluation process. This is most often done by mental health professionals, and/or pediatricians. Unless there are complicating factors, it is usually unnecessary for this evaluation to be done by psychiatrists or neurologists. In addition to a clinical interview with the parents and child and a developmental history, behavior rating forms are generally completed by the parents and teachers. There are no blood tests or other simple medical procedures to establish a diagnosis. While brain scans continue to be researched, they are not routinely used by most clinicians. The added benefit to performing brain scans has yet to be demonstrated.
Stimulant medications, such as Ritalin are the most widely used treatment and have been used since the 1950s. They are effective for most and are considered safe and generally well tolerated. Medications, when indicated, are usually prescribed by the pediatrician or family physician.
Behavioral strategies are often helpful. It is ineffective to say "Be good for a week and you'll get a reward." Immediate reinforcement for on-task behavior and good efforts are what will work best. The person needs to learn to monitor themselves and bring themselves back to the task on hand. Children are not able to do this. They often require frequent redirection. They also do much better when adults are able to provide structure for them. Yelling and punishment will almost always make things worse.
A form of biofeedback called neurofeedback is probably effective. However, it needs to be performed several times a week and is not covered by insurance.
There are a handful of small studies that have shown meditation to improve symptoms of ADHD. .Meditation trains people to focus on one thing, be it the breath, a word or short phrase, bringing their mind back to that focus wherever it wanders. I believe how this works is it gets people to pay attention to their thinking, as well as practicing noticing their mind wandering, as well as bringing it back when it wanders. A good book is The Mindfulness Prescription for Adult ADHD: An 8-Step Program for Strengthening Attention, Managing Emotions, and Achieving Your Goals by Lydia Zylowska. The book includes a CD of recorded mindfulness meditations. Recently, a new website http://mindfullyadd.com was started. While they want you to subscribe to their services, you can get some information for free.
For many decades, the prevailing theory was ADHD was something that was outgrown somewhere during adolescence. While there were a few papers from the late 1960's, it really wasn't until the 1990's, there has been increasing awareness that many adults do NOT outgrow ADHD. Studies showed that ADHD in children persisted into adolescence for about 70% and for up to 66% for adults.
Increased research and the use of brain scans have confirmed this. It has been estimated that there are three times the number of adults with ADHD than children. Adults who were never diagnosed or treated show a higher rate of alcohol/substance abuse, vocational, marital, social problems, as well as increased tendencies for anxiety and depression.
A GREAT book for adults is More attention. Less deficit. Success strategies for adults with ADHD by Ari Tuckman. The book is written in short sections, making this much more user friendly to adults with ADHD. He also has a website that should be checked out www.adultadhdbook.com. There are over 100 "podcasts" that are taken from the book, lasting from 5 to 12 minute. There are also about 50 of these podcasts on iTunes (search Ari Tuckman), where they are much better organized.
Another great resource is AddClasses.com. Once or twice a month they have free webinars by leaders in the field. You can listen to recordings for one week, before it becomes part of their subscription library.
A quarterly magazine addressing ADHD is Additude magazine. They have numerous, free articles on all aspects of ADHD. You can also sign up for free newsletters. It is definitely worth checking out at Additude Magazine.
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